Language
English
Publication Date
5-21-2024
Journal
Journal of the American College of Cardiology
DOI
10.1016/j.jacc.2024.02.050
PMID
38749620
PMCID
PMC11460524
PubMedCentral® Posted Date
5-21-2025
PubMedCentral® Full Text Version
Author MSS
Abstract
The identification of the pulmonary veins as a trigger source for atrial fibrillation (AF) has established pulmonary vein isolation (PVI) as a key target for AF ablation. However, PVI alone does not prevent recurrent AF in many patients, and numerous additional ablation strategies have failed to improve on PVI outcomes. This therapeutic limitation may be due, in part, to a failure to identify and intervene specifically on the pro-fibrillatory substrate within the atria and pulmonary veins. In this review paper, we highlight several emerging approaches with clinical potential that target atrial cardiomyopathy-the underlying anatomic, electrical, and/or autonomic disease affecting the atrium-in various stages of practice and investigation. In particular, we consider the evolving roles of risk factor modification, targeting of epicardial adipose tissue, tissue fibrosis, oxidative stress, and the inflammasome, along with aggressive early anti-AF therapy in AF management. Attention to combatting substrate development promises to improve outcomes in AF.
Keywords
Atrial Fibrillation, Humans, Catheter Ablation, Pulmonary Veins, atrial cardiomyopathy, atrial fibrillation, early intervention, epicardial adipose tissue, fibrosis, inflammasome, obesity, oxidative stress
Published Open-Access
yes
Recommended Citation
McCauley, Mark D; Iacobellis, Gianluca; Li, Na; et al., "Targeting the Substrate for Atrial Fibrillation: JACC Review Topic of the Week" (2024). Faculty, Staff and Students Publications. 6335.
https://digitalcommons.library.tmc.edu/baylor_docs/6335