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Chapter-23 Atrial Fibrillation:Classification and Mechanisms of Initiation and Maintenance

BOOK TITLE: Practical Cardiac Electrophysiology

Author
1. Shah Ashok
2. Derval Nicolas
3. Pambrun Thomas
4. Amraoui Sana
5. Yamashita Seigo
6. Berte Benjamin
7. Al-Jefairi Noora
8. Frontera Antonio
9. Hooks Darren
10. Denis Arnaud
11. Sacher Frédéric
12. Hocini Mélèze
13. Jais Pierre
14. Haissaguerre Michel
ISBN
9789386056795
DOI
10.5005/jp/books/13028_24
Edition
1/e
Publishing Year
2017
Pages
14
Author Affiliations
1. Vallabhbhai Patel Chest Institute, University of Delhi, PO Box 2101, Delhi, India, Grant Medical College and Sir JJ Group of Hospitals; Harkisandas Hospital Breach Candy Hospital, Mumbai, Maharashtra, India, VP Chest Institute, University of Delhi, PO Box 2101, New Delhi, India, VP Chest Institute, University of Delhi, P.O. Box 2101, Delhi, Harkisondas Hospital, Breach Candy Hospital, Mumbai, India, VP Chest Institute, University of Delhi, Delhi, India, Peel Health Campus, Mandurah, WA, Australia, Vallabhbhai Patel Chest Institute, New Delhi, India, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
2. IHU LIRYC, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux University Hospital (CHU), Pessac, France
3. Hôpital Cardiologique du Haut-Lévêque and the Université de Bordeaux, Bordeaux, France
4. IHU LIRYC, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux University Hospital (CHU), Pessac, France
5. IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux University Hospital (CHU), Pessac, France
6. IHU LIRYC, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux University Hospital (CHU), Pessac, France
7. IHU LIRYC, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux University Hospital (CHU), Pessac, France
8. IHU LIRYC, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux University Hospital (CHU), Pessac, France
9. IHU LIRYC, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux University Hospital (CHU), Pessac, France
10. IHU LIRYC, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux University Hospital (CHU), Pessac, France
11. IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University, Bordeaux University Hospital (CHU) Pessac, France
12. LIRYC institute, Hopital du Haut-Lévèque et, University de Bordeaux, Pessac, France
13. CHU Bordeaux, Université de Bordeaux, LIRYC, Bordeaux, France
14. IHU LIRYC, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux University Hospital (CHU), Pessac, France
Chapter keywords
Atrial fibrillation, AF, paroxysmal AF, persistent AF, primary AF, secondary AF, nonvalvular AF, permanent AF

Abstract

The aim of this chapter discusses the classification of atrial fibrillation (AF). AF is the most common cardiac arrhythmia. Irregular RR intervals, no distinct P waves on electrocardiography and the atrial cycle length (when visible) are the electrocardiographic characteristics of AF. Primary versus secondary, nonvalvular versus valvular, symptomatic versus silent, line versus in structurally diseased heart and first diagnosed (index episode) versus recurrent are the different classifications of AF. AF is the clinical manifestation of a chain of subclincal events, which lead to alterations in the structure (pathophysiology) and electrical properties (electrophysiology) of the atrial myocardium. Phase-based computational analysis is the most recently used technique to map clinical AF and decipher its mechanisms. This technique has been applied to electrical signals acquired using high-density contact tools like multielectrode basket catheters, invasively or reconstructed by inversing 252-lead surface electrocardiogram (ECG) on CT-derived biatrial geometry, non-invasively. Mechanisms of initiation and maintenance of AF are also discussed in this chapter.

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