Advertisement
Review| Volume 131, ISSUE 2, P180-185, January 09, 2009

Download started.

Ok

‘Lone’ atrial fibrillation: Hunting for the underlying causes and links

      Abstract

      The presence of lone atrial fibrillation presupposes the absence of structural heart disease, hypertension, or other known predisposing factors. However, several recent clinical and experimental data provide novel insights into the pathogenesis of lone atrial fibrillation. In addition, modern diagnostic techniques often reveal some previously unappreciated abnormalities. Therefore, the increasing recognition of potential causes and links sets the base for a more complete elucidation of its etiology in the near future. This concise review article discusses the contemporary advances in the understanding of this form of atrial fibrillation.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chen L.Y.
        • Shen W.K.
        Epidemiology of atrial fibrillation: a current perspective.
        Heart Rhythm. 2007; 4: S1-S6
        • Lip G.Y.H.
        • Watson T.
        Atrial fibrillation — the growing epidemic.
        Heart. 2007; 93: 542-543
        • Korantzopoulos P.
        • Kolettis T.M.
        • Goudevenos J.A.
        • Siogas K.
        Errors and pitfalls in the non-invasive management of atrial fibrillation.
        Int J Cardiol. 2005; 104: 125-130
        • Gersh B.J.
        • Solomon A.
        Lone atrial fibrillation: epidemiology and natural history.
        Am Heart J. 1999; 137: 592-595
        • Fuster V.
        • Ryden L.E.
        • Cannom D.S.
        • et al.
        American College of Cardiology; American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation.
        Europace. 2006; 8: 651-745
        • Levy S.
        • Camm A.J.
        • Saksena S.
        • et al.
        International consensus on nomenclature and classification of atrial fibrillation; a collaborative project of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.
        Europace. 2003; 5: 119-122
        • Jahangir A.
        • Lee V.
        • Friedman P.A.
        • et al.
        Long-term progression and outcomes with aging in patients with lone atrial fibrillation. A 30-year follow-up study.
        Circulation. 2007; 115: 3050-3056
        • Thrall G.
        • Lane D.
        • Carroll D.
        • Lip G.Y.
        Quality of life in patients with atrial fibrillation: a systematic review.
        Am J Med. 2006; 119: e1-19
        • Lorbar M.
        • Spodick D.H.
        ‘Idiopathic’ pericarditis — the clinician's challenge [nothing is idiopathic].
        Int J Clin Pract. 2007; 61: 138-142
        • Van Wagoner D.R.
        Recent insights into the pathophysiology of atrial fibrillation.
        Semin Thorac Cardiovasc Surg. 2007; 19: 9-15
        • Frost L.
        Lone atrial fibrillation: good, bad, or ugly?.
        Circulation. 2007; 115: 3040-3041
        • Shiroshita-Takeshita A.
        • Brundel B.J.J.M.
        • Nattel S.
        Atrial fibrillation: basic mechanisms, remodeling, and triggers.
        J Interv Card Electrophysiol. 2005; 13: 181-193
        • Wang T.J.
        • Benjamin E.J.
        The epidemiology of atrial fibrillation.
        in: Kowey P. Naccarelli G.V. Atrial fibrillation. Marcel Dekker, New York2005: 1-26
        • Gami A.S.
        • Hodge D.O.
        • Herges R.M.
        • et al.
        Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation.
        J Am Coll Cardiol. 2007; 49: 565-571
        • Dublin S.
        • French B.
        • Glazer N.L.
        • et al.
        Risk of new-onset atrial fibrillation in relation to body mass index.
        Arch Intern Med. 2006; 166: 2322-2328
        • Movahed M.R.
        • Hashemzadeh M.
        • Jamal M.M.
        Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease.
        Int J Cardiol. 2005; : 105:315-318
        • Umetani K.
        • Kodama Y.
        • Nakamura T.
        • et al.
        High prevalence of paroxysmal atrial fibrillation and/or atrial flutter in metabolic syndrome.
        Circ J. 2007; 71: 252-255
        • Frost L.
        • Vestergaard P.
        Alcohol and risk of atrial fibrillation or flutter: a cohort study.
        Arch Intern Med. 2004; 164: 1993-1998
        • Eaker E.D.
        • Sullivan L.M.
        • Kelly-Hayes M.
        • D'Agostino Sr., R.B.
        • Benjamin E.J.
        Anger and hostility predict the development of atrial fibrillation in men in the Framingham Offspring Study.
        Circulation. 2004; 109: 1267-1271
        • Mitchell G.F.
        • Vasan R.S.
        • Keyes M.J.
        • et al.
        Pulse pressure and risk of new-onset atrial fibrillation.
        JAMA. 2007; 297: 709-715
        • Heeringa J.
        • van der Kuip D.A.
        • Hofman A.
        • et al.
        Subclinical atherosclerosis and risk of atrial fibrillation: the Rotterdam study.
        Arch Intern Med. 2007; 167: 382-387
        • Katritsis D.G.
        • Toumpoulis I.K.
        • Giazitzoglou E.
        • et al.
        Latent arterial hypertension in apparently lone atrial fibrillation.
        J Interv Card Electrophysiol. 2005; 13: 203-207
        • Patton K.K.
        • Zacks E.S.
        • Chang J.Y.
        • et al.
        Clinical subtypes of lone atrial fibrillation.
        Pacing Clin Electrophysiol. 2005; 28: 630-638
        • Chambers P.W.
        Lone atrial fibrillation: pathologic or not?.
        Med Hypotheses. 2007; 68: 281-287
        • Chen J.
        • Wasmund S.L.
        • Hamdan M.H.
        Back to the future: the role of the autonomic nervous system in atrial fibrillation.
        Pacing Clin Electrophysiol. 2006; 29: 413-421
        • Podrid P.J.
        Etiology and pathogenesis of atrial fibrillation.
        in: Kowey P. Naccarelli G.V. Atrial fibrillation. Marcel Dekker, New York2005: 27-60
        • Mont L.
        • Sambola A.
        • Brugada J.
        • et al.
        Long-lasting sport practice and lone atrial fibrillation.
        Eur Heart J. 2002; 23: 477-482
        • Elosua R.
        • Arquer A.
        • Mont L.
        • et al.
        Lone atrial fibrillation and sport practice. The no gain without pain history revisited again?.
        Int J Cardiol. 2007; 118: 414-415
        • van der Hooft C.S.
        • Heeringa J.
        • van Herpen G.
        • Kors J.A.
        • Kingma J.H.
        • Stricker B.H.
        Drug-induced atrial fibrillation.
        J Am Coll Cardiol. 2004; 44: 2117-2124
        • Tsang T.S.
        • Gersh B.J.
        • Appleton C.P.
        • et al.
        Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women.
        J Am Coll Cardiol. 2002; 40: 1636-1644
        • Li J.
        • Wang L.
        B-type natriuretic peptide levels in patients with paroxysmal lone atrial fibrillation.
        Heart Vessels. 2006; 21: 137-140
        • Lee S.H.
        • Jung J.H.
        • Choi S.H.
        • et al.
        Determinants of brain natriuretic peptide levels in patients with lone atrial fibrillation.
        Circ J. 2006; 70: 100-104
        • Osranek M.
        • Bursi F.
        • Bailey K.R.
        • et al.
        Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: three-decade follow-up.
        Eur Heart J. 2005; 26: 2556-2561
        • Sitges M.
        • Teijeira V.A.
        • Scalise A.
        • et al.
        Is there an anatomical substrate for idiopathic paroxysmal atrial fibrillation? A case–control echocardiographic study.
        Europace. 2007; 9: 294-298
        • Phang R.S.
        • Isserman S.M.
        • Karia D.
        • et al.
        Echocardiographic evidence of left atrial abnormality in young patients with lone paroxysmal atrial fibrillation.
        Am J Cardiol. 2004; 94: 511-513
        • Kosmala W.
        • Przewlocka-Kosmala M.
        • Mazurek W.
        Abnormalities of pulmonary venous flow in patients with lone atrial fibrillation.
        Europace. 2006; 8: 102-106
        • Reant P.
        • Lafitte S.
        • Jais P.
        • et al.
        Reverse remodeling of the left cardiac chambers after catheter ablation after 1 year in a series of patients with isolated atrial fibrillation.
        Circulation. 2005; 112: 2896-2903
        • Nanthakumar K.
        • Lau Y.R.
        • Plumb V.J.
        • Epstein A.E.
        • Kay G.N.
        Electrophysiological findings in adolescents with atrial fibrillation who have structurally normal hearts.
        Circulation. 2004; 110: 117-123
        • Todd D.M.
        • Skanes A.C.
        • Guiraudon G.
        • et al.
        Role of the posterior left atrium and pulmonary veins in human lone atrial fibrillation: electrophysiological and pathological data from patients undergoing atrial fibrillation surgery.
        Circulation. 2003; 108: 3108-3114
        • Haïssaguerre M.
        • Jaïs P.
        • Shah D.C.
        • et al.
        Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.
        N Engl J Med. 1998; 339: 659-666
        • Lin W.S.
        • Tai C.T.
        • Hsieh M.H.
        • et al.
        Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy.
        Circulation. 2003; 107: 3176-3183
        • Chou C.C.
        • Chen P.S.
        New concepts in atrial fibrillation: mechanism and remodeling.
        Med Clin North Am. 2008; 92: 53-63
        • Wiesfeld A.C.
        • Hemels M.E.
        • Van Tintelen J.P.
        • Van den Berg M.P.
        • Van Veldhuisen D.J.
        • Van Gelder I.C.
        Genetic aspects of atrial fibrillation.
        Cardiovasc Res. 2005; 67: 414-418
        • Fox C.S.
        • Parise H.
        • D'Agostino Sr., R.B.
        • et al.
        Parental atrial fibrillation as a risk factor for atrial fibrillation in offspring.
        JAMA. 2004; 291: 2851-2855
        • Darbar D.
        • Herron K.J.
        • Ballew J.D.
        • et al.
        Familial atrial fibrillation is a genetically heterogeneous disorder.
        J Am Coll Cardiol. 2003; 41: 2185-2192
        • Ellinor P.T.
        • Yoerger D.M.
        • Ruskin J.N.
        • MacRae C.A.
        Familial aggregation in lone atrial fibrillation.
        Hum Genet. 2005; 118: 179-184
        • Kato K.
        • Oguri M.
        • Hibino T.
        • et al.
        Genetic factors for lone atrial fibrillation.
        Int J Mol Med. 2007; 19: 933-939
        • Fatkin D.
        • Otway R.
        • Vandenberg J.I.
        Genes and atrial fibrillation: a new look at an old problem.
        Circulation. 2007; 116: 782-792
        • Firouzi M.
        • Ramanna H.
        • Kok B.
        • et al.
        Association of human connexin40 gene polymorphisms with atrial vulnerability as a risk factor for idiopathic atrial fibrillation.
        Circ Res. 2004; 95: e29-33
        • Gollob M.H.
        • Jones D.L.
        • Krahn A.D.
        • et al.
        Somatic mutations in the connexin 40 gene (GJA5) in atrial fibrillation.
        N Engl J Med. 2006; 354: 2677-2688
        • Tsai C.T.
        • Lai L.P.
        • Lin J.L.
        • et al.
        Renin–angiotensin system gene polymorphisms and atrial fibrillation.
        Circulation. 2004; 109: 1640-1646
        • Fatini C.
        • Sticchi E.
        • Gensini F.
        • et al.
        Lone and secondary nonvalvular atrial fibrillation: role of a genetic susceptibility.
        Int J Cardiol. 2007; 120: 59-65
        • Chen L.Y.
        • Ballew J.D.
        • Herron K.J.
        • Rodeheffer R.J.
        • Olson T.M.
        A common polymorphism in SCN5A is associated with lone atrial fibrillation.
        Clin Pharmacol Ther. 2007; 81: 35-41
        • Morita H.
        • Kusano-Fukushima K.
        • Nagase S.
        • et al.
        Atrial fibrillation and atrial vulnerability in patients with Brugada syndrome.
        J Am Coll Cardiol. 2002; 40: 1437-1444
        • Letsas K.P.
        • Sideris A.
        • Efremidis M.
        • et al.
        Prevalence of paroxysmal atrial fibrillation in Brugada syndrome: a case series and a review of the literature.
        J Cardiovasc Med. 2007; 8: 803-806
        • Junttila M.J.
        • Raatikainen M.J.
        • Perkiömäki J.S.
        • Hong K.
        • Brugada R.
        • Huikuri H.V.
        Familial clustering of lone atrial fibrillation in patients with saddleback-type ST-segment elevation in right precordial leads.
        Eur Heart J. 2007; 28: 463-468
        • Poglajen G.
        • Fister M.
        • Radovancevic B.
        • Vrtovec B.
        Short QT interval and atrial fibrillation in patients without structural heart disease.
        J Am Coll Cardiol. 2006; 47: 1905-1907
        • Ehrlich J.R.
        • Hohnloser S.H.
        • Nattel S.
        Role of angiotensin system and effects of its inhibition in atrial fibrillation: clinical and experimental evidence.
        Eur Heart J. 2006; 27: 512-518
        • Ellinor P.T.
        • Low A.F.
        • Macrae C.A.
        Reduced apelin levels in lone atrial fibrillation.
        Eur Heart J. 2006; 27: 222-226
        • Boos C.J.
        • Anderson R.A.
        • Lip G.Y.
        Is atrial fibrillation an inflammatory disorder?.
        Eur Heart J. 2006; 27: 136-149
        • Liu T.
        • Li G.
        • Li L.
        • Korantzopoulos P.
        Association between C-reactive protein and recurrence of atrial fibrillation after successful electrical cardioversion: a meta-analysis.
        J Am Coll Cardiol. 2007; 49: 1642-1648
        • Frustaci A.
        • Chimenti C.
        • Bellocci F.
        • Morgante E.
        • Russo M.A.
        • Maseri A.
        Histological substrate of atrial biopsies in patients with lone atrial fibrillation.
        Circulation. 1997; 96: 1180-1184
        • Ellinor P.T.
        • Low A.
        • Patton K.K.
        • Shea M.A.
        • MacRae C.A.
        C-reactive protein in lone atrial fibrillation.
        Am J Cardiol. 2006; 97: 1346-1350
        • Hatzinikolaou-Kotsakou E.
        • Tziakas D.
        • Hotidis A.
        • et al.
        Relation of C-reactive protein to the first onset and the recurrence rate in lone atrial fibrillation.
        Am J Cardiol. 2006; 97: 659-661
        • Gedikli O.
        • Dogan A.
        • Altuntas I.
        • et al.
        Inflammatory markers according to types of atrial fibrillation.
        Int J Cardiol. 2007; 120: 193-197
        • Maixent J.M.
        • Paganelli F.
        • Scaglione J.
        • Lévy S.
        Antibodies against myosin in sera of patients with idiopathic paroxysmal atrial fibrillation.
        J Cardiovasc Electrophysiol. 1998; 9: 612-617