Mechanisms of disease: Atrial fibrillation

ATRIAL FIBRILLATION (AF) is the most common sustained dysrhythmia in adults. It is ironic, then, that although mechanisms and effective treatments for most other supraventricular tachyarrhythmias have been discovered, AF remains incompletely understood and poorly treated. Nonetheless, our understanding of the pathophysiology of AF has improved in the last half-century, including some groundbreaking observations made in the last 10 years. Indeed, for some patients, the potential for cure now appears to be available. Because no unifying mechanism of AF has been proven, the aim of this review is to describe some of the common and important concepts behind current mechanistic theories of AF and how they contribute to our clinical understanding of AF.     

Atrial fibrillation: an unusual cause

A 28-year-old male presenting with atrial fibrillation (AF) underwent successful electrical cardioversion to restore sinus rhythm. He had no prior history of AF or other cardiac disease. However, transthoracic echocardiography (TTE), performed to exclude structural abnormalities as a cause of AF, demonstrated a large mass in the left atrium (LA). For further analysis the patient was referred to our centre, and echocardiography, multislice detector computed tomography (MDCT) and cardiovascular magnetic resonance imaging (CMR) were performed for further noninvasive diagnostic work-up.     

Atrial fibrillation in the elderly

Atrial fibrillation (AF) is prevalent in the elderly (affecting 5% of persons aged >or= 65 years and around 10% of those aged >or= 80 years old) and is associated with stroke, heart failure and poor quality of life. The symptoms of AF are palpitations, fatigue, reduced exercise capacity, dyspnea or dizziness. AF is associated with comorbidity, mainly hypertension in outpatients, and ischaemic heart disease and heart failure in hospitalized patients. Two therapeutic strategies are available to treat arrhythmia: rhythm control or frequency control. In many elderly patients with AF, frequency control is an effective option, particularly when there is heart failure, contraindications to antiarrhythmic agents or when cardioversion is not indicated. Anticoagulation is the main measure to reduce stroke risk. If anticoagulation is not appropriate for a patient, antiaggregants can be used, but the benefit is clearly lower than that provided by anticoagulation.     

Atrial fibrillation: the role of hypoxia-inducible factor-1-regulated cytokines

Molecular and Cellular Biochemistry - Atrial fibrillation (AF) is a common arrhythmia that has major morbidity and mortality. Hypoxia plays an important role in AF initiation and maintenance....     

Identification of nonstationary dynamics in physiological recordings

We present a novel framework for the analysis of time series from dynamical systems that alternate between different operating modes. The method simultaneously segments and identifies the dynamical modes by using predictive models. In extension to previous approaches, it allows an identification of smooth transition between successive modes. The method can be used for analysis, diagnosis, prediction, and control. In an application to EEG and respiratory data recorded from humans during afternoon naps, the obtained segmentations of the data agree with the sleep stage segmentation of a medical expert to a large extent. However, in contrast to the manual segmentation, our method does not require a priori knowledge about physiology. Moreover, it has a high temporal resolution and reveals previously unclassified details of the transitions. In particular, a parameter is found that is potentially helpful for vigilance monitoring. We expect that the method will generally be useful for the analysis of nonstationary dynamical systems, which are abundant in medicine, chemistry, biology and engineering. Received: 5 May 1999 / Accepted in revised form: 28 December 1999     

Atrial fibrillation: trends in prevalence and antithrombotic prescriptions in the community

Netherlands Heart Journal - In the past decade, the atrial fibrillation (AF) landscape, including the treatment modalities, has drastically changed. This raises the question how AF prevalence and...     

Atrial pacing for rhythm control of atrial fibrillation

After atrial fibrillation (AF) develops, the first step is to search for and treat underlying (heart) s. Thereafter, AF should be treated. This includes prevention of cardiovascular morbidity and mortality, especially vascular events, and reduction of symptoms.1 The latter may be obtained by two treatment strategies: rhythm-control and/or rate-control treatment. Recent randomised trials have shown that rate control is not inferior to rhythm control with regard to cardiovascular morbidity and mortality.2 In these studies, predominantly elderly patients with underlying heart s (especially hypertension) were included. Patients with (severely) symptomatic AF and advanced heart failure were excluded. Since then, rate-control treatment has been adopted more frequently, even as first-choice therapy, especially in the elderly.     

Characterization of chaotic dynamics in the human menstrual cycle

Background  

The human menstrual cycle is known to exhibit a significant amount of unexplained variability. This variation is typically dismissed as random fluctuations in an otherwise periodic and predictable system. Given the many delayed nonlinear feedbacks in the multiple levels of the reproductive endocrine system, however, the menstrual cycle can properly be construed as the output of a nonlinear dynamical system, and such a system has the possibility of being in a chaotic trajectory. We hypothesize that this is in fact the case and that it accounts for the observed variability.     

Quantification of emotion by nonlinear analysis of the chaotic dynamics of electroencephalograms during perception of 1/f music

The goal of this study is to quantify and determine the way in which the emotional response to music is reflected in the electrical activities of the brain. When the power spectrum of sequences of musical notes is inversely proportional to the frequency on a log-log plot, we call it 1/f music. According to previous research, most listeners agree that 1/f music is much more pleasing than white (1/f ⁰) or brown (1/f ²) music. Based on these studies, we used nonlinear methods to investigate the chaotic dynamics of electroencephalograms (EEGs) elicited by computer-generated 1/f music, white music, and brown music. In this analysis, we used the correlation dimension and the largest Lyapunov exponent as measures of complexity and chaos. We developed a new method that is strikingly faster and more accurate than other algorithms for calculating the nonlinear invariant measures from limited noisy data. At the right temporal lobe, 1/f music elicited lower values of both the correlation dimension and the largest Lyapunov exponent than white or brown music. We observed that brains which feel more pleased show decreased chaotic electrophysiological behavior. By observing that the nonlinear invariant measures for the 1/f distribution of the rhythm with the melody kept constant are lower than those for the 1/f distribution of melody with the rhythm kept constant, we could conclude that the rhythm variations contribute much more to a pleasing response to music than the melody variations do. These results support the assumption that chaos plays an important role in brain function, especially emotion. Received: 30 December 1996 / Accepted in revised form: 18 December 1997     

Sponge cell reaggregation: Mechanisms and dynamics of the process

Sponges (Porifera) are lower metazoans whose organization is characterized by a high plasticity of anatomical and cellular structures. One of the manifestations of this plasticity is the ability of sponge cells to reaggregate after dissociation of tissues. This review brings together the available data on the reaggregation of sponge cells that have been obtained to date since the beginning of the 20th century. It considers the behavior of dissociated cells in suspension, the mechanisms and factors involved in reaggregation, and the rate and stages of this process in different representatives of this phylum. In addition, this review provides information about the histological structure of multicellular aggregates formed during reaggregation of cells and the regenerative morphogenetic processes leading to the formation of normal sponges from these multicellular aggregates.     

Modeling observed chaotic oscillations in bursting neurons: the role of calcium dynamics and IP3

We study the dynamics and stability of legged locomotion in the horizontal plane. We discuss the relevance of idealized mechanical models, developed in a companion paper, to recent experiments and simulations on insect running and turning. Applying our results to rapidly running cockroaches, we show that the models' gait and force characteristics match observations reasonably well. Received: 6 September 1999 / Accepted in revised form: 8 May 2000     

Ventricular fibrillation: the current methods for analysing the degree of irregularity of the process

Ventricular fibrillation has traditionally been described as "chaotic" and in recent years there has been discussions that fibrillation may be an instance of deterministic chaos in the context of nonlinear dynamical systems theory. The current paper summarizes modern methods of mathematical analysis of the degree of electrical irregularities of the heart during VF. The traditional methods of Fourier analysis of electrocardiographic data as well as concepts of chaos theory--fractal dimension, entropy, reconstruction of attractors and some new methods such as spatial coherence have been considered. The results are discussed in context of mathematical models and hypothesis of mechanisms of VF.     

Vague-to-crisp dynamics of percept formation modeled as operant (selectionist) process

We model the vague-to-crisp dynamics of forming percepts in the brain by combining two methodologies: dynamic logic (DL) and operant learning process. Forming percepts upon the presentation of visual inputs is likened to model selection based on sampled evidence. Our framework utilizes the DL in selecting the correct “percept” among competing ones, but uses an intrinsic reward mechanism to allow stochastic online update in lieu of performing the optimization step of the DL framework. We discuss the connection of our framework with cognitive processing and the intentional neurodynamic cycle.