Understanding Atrial Fibrillation

DESCRIPTION:

A new guide to the mechanisms and principles behind the world’s most common abnormal heart rhythm

 Affecting 30 million or more people across the globe, atrial fibrillation is one of the most prevalent – and yet misapprehended – issues facing modern cardiology. Its potential causes and optimal treatment strategies are matters of some conjecture in the medical community, where ongoing research has yielded findings that can prove challenging to those not familiar with the complex physiology at the root of the condition. Recognizing these concerns, distinguished electrophysiologist Peter Spector has designed Understanding Atrial Fibrillation as a means by which to equip clinicians with the data and analytic tools needed to develop a better grasp of this arrhythmia’s full nature.    

The book begins by providing a detailed explanation of atrial fibrillation’s causal mechanisms and builds its exploration from there. Working toward an up-to-date knowledge of the mapping and ablation of atrial fibrillation, its chapters assess the experimental data that has shaped current thoughts on the condition and then outline the best methods with which to interpret that rich but potentially difficult information. This revelatory new guide:    

Explores hypotheses of multiple drivers and mechanisms co-existing in individual patients

Addresses common misperceptions and inaccurate views about atrial fibrillation

Describes the basic physiology of atrial fibrillation’s propagation and reentry

Explores the various mechanisms and higher-order dynamics of fibrillation

Discusses how to intervene and alter atrial physiology to prevent fibrillation

Understanding Atrial Fibrillation is truly an invaluable resource for physicians, fellows, residents, electrophysiology lab staff, and all other practitioners involved in the diagnosis and treatment of atrial fibrillation.

TABLE OF CONTENTS:

Preface ix

Acknowledgments xiii

Part I: Building blocks of fibrillation 1

Excitation and propagation 1

Source-sink relationships 2

What determines source-sink balance? 3

Propagation and reentry 4

Requirements for reentry 4

What makes a circuit? 6

Source-sink balance and rotors 6

Wave length 8

Wave length, path length, and reentry 9

Restitution 10

Initiating reentry 11

Part II: Atrial fibrillation mechanisms 21

The evolution of current concepts 21

The mass hypothesis of atrial fibrillation 30

Principles of propagation: Implications for fibrillation 32

Focal rotors 52

Micro‐reentry 55

Fibrillatory conduction or multi‐wavelet reentry? 66

Location of atrial fibrillation drivers 76

Principles of propagation: Driver interactions in fibrillation 87

Part III: Working with incomplete information 93

Cardiac mapping 93

Sample density and atrial fibrillation 115

What should we do with the patient who comes to the lab tomorrow? Putting it all together (without “it all”) 128

Putting it all together: Atrial fibrillation in three questions 132

Appendix A: Calculating probability in a random walk 135

Appendix B: Dominant frequency analysis 137

Appendix C: A stupid idea, but a learning opportunity 143

References 149

Index 161