Prevention of Pathological Atrial Remodeling and Atrial Fibrillation: JACC State-of-the-Art Review

Yi Ching Chen; Aleksandr Voskoboinik; Andre La Gerche; Thomas H Marwick; Julie R McMullen

doi:10.1016/j.jacc.2021.04.012

Prevention of Pathological Atrial Remodeling and Atrial Fibrillation: JACC State-of-the-Art Review

J Am Coll Cardiol. 2021 Jun 8;77(22):2846-2864. doi: 10.1016/j.jacc.2021.04.012.

Authors

Yi Ching Chen¹, Aleksandr Voskoboinik², Andre La Gerche³, Thomas H Marwick⁴, Julie R McMullen⁵

Affiliations

¹ Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
² Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Heart Center, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia.
³ Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia; National Centre for Sports Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
⁴ Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Heart Center, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia. Electronic address: Tom.marwick@baker.edu.au.
⁵ Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia; Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia. Electronic address: Julie.mcmullen@baker.edu.au.

PMID: 34082914
DOI: 10.1016/j.jacc.2021.04.012

Abstract

Atrial enlargement in response to pathological stimuli (e.g., hypertension, mitral valve disease) and physiological stimuli (exercise, pregnancy) can be comparable in magnitude, but the diseased enlarged atria is associated with complications such as atrial fibrillation (AF), whereas physiological atrial enlargement is not. Pathological atrial enlargement and AF is also observed in a small percentage of athletes undergoing extreme/intense endurance sport and pregnant women with preeclampsia. Differences between physiological and pathological atrial enlargement and underlying mechanisms are poorly understood. This review describes human and animal studies characterizing atrial enlargement under physiological and pathological conditions and highlights key knowledge gaps and clinical challenges, including: 1) the limited ability of atria to reverse remodel; and 2) distinguishing physiological and pathological enlargement via imaging/biomarkers. Finally, this review discusses how targeting distinct molecular mechanisms underlying physiological and pathological atrial enlargement could provide new therapeutic and diagnostic strategies for preventing or reversing atrial enlargement and AF.

Keywords: atrial remodeling; exercise; heart disease; pregnancy; reverse remodeling; treatment.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't
Review

MeSH terms

Animals
Athletes
Atrial Fibrillation / etiology
Atrial Fibrillation / prevention & control
Atrial Remodeling*
Female
Heart Diseases / physiopathology*
Humans
Pregnancy / physiology
Sex Characteristics