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Gepubliceerd in:

01-11-2010 | Editorial

Upstream therapy in patients with early atrial fibrillation

The relevance of the Routine versus Aggressive upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study

Auteurs: I.C. Van Gelder, M.D. Smit, M. Alings, H.J.G.M. Crijns

Gepubliceerd in: Netherlands Heart Journal | Uitgave 11/2010

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Extract

Atrial fibrillation (AF) is not a benign disease. It is associated with an increased risk of death, stroke, heart failure and hospitalisation, an impaired quality of life, and reduced exercise capacity and left ventricular dysfunction. Development of AF is a result of continuous remodelling of the atria, altered metabolism and autonomic changes secondary to ageing, progression of the underlying heart disease, and genetic and environmental factors. Hypertension, congestive heart failure, ischaemic heart disease, and diabetes are all wellknown risk factors for the development of AF.1 The first manifestation of AF usually occurs after years of atrial and ventricular remodelling, caused by hypertension or heart failure (figure 1).2 Important substrates for AF are fibrosis and inflammation, which form the basis of atrial and ventricular remodelling. One mechanism involved in these processes is activation of the renin-angiotensin-aldosterone system (RAAS), causing increased levels of angiotensin-II and aldosterone, which stimulate fibrosis, hypertrophy and inflammation.3,4
Literatuur
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go back to reference Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; doi:10.1093/eurheartj/ehq278. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; doi:10.1093/eurheartj/ehq278.
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go back to reference Cosio FG, Aliot E, Botto GL, Heidbuchel H, Geller CJ, Kirchhof P, et al. Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode. Europace. 2008;10:21–27.PubMedCrossRef Cosio FG, Aliot E, Botto GL, Heidbuchel H, Geller CJ, Kirchhof P, et al. Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode. Europace. 2008;10:21–27.PubMedCrossRef
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go back to reference Kourliouros A, Savelieva I, Kiotsekoglou A, Jahangiri M, Camm J. Current concepts in the pathogenesis of atrial fibrillation. Am Heart J. 2009;157:243–252.PubMedCrossRef Kourliouros A, Savelieva I, Kiotsekoglou A, Jahangiri M, Camm J. Current concepts in the pathogenesis of atrial fibrillation. Am Heart J. 2009;157:243–252.PubMedCrossRef
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go back to reference Milliez P, Deangelis N, Rucker-Martin C, Leenhardt A, Vicaut E, Robidel E, et al. Spironolactone reduces fibrosis of dilated atria during heart failure in rats with myocardial infarction. Eur Heart J. 2005;26:2193–2199.PubMedCrossRef Milliez P, Deangelis N, Rucker-Martin C, Leenhardt A, Vicaut E, Robidel E, et al. Spironolactone reduces fibrosis of dilated atria during heart failure in rats with myocardial infarction. Eur Heart J. 2005;26:2193–2199.PubMedCrossRef
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go back to reference Erbs S, Linke A, Gielen S, Fiehn E, Walther C, Yu J, et al. Exercise training in patients with severe chronic heart failure: impact on left ventricular performance and cardiac size. A retrospective analysis of the Leipzig Heart Failure Training Trial. Eur J Cardiovasc Prev Rehabil. 2003;10:336–344.PubMedCrossRef Erbs S, Linke A, Gielen S, Fiehn E, Walther C, Yu J, et al. Exercise training in patients with severe chronic heart failure: impact on left ventricular performance and cardiac size. A retrospective analysis of the Leipzig Heart Failure Training Trial. Eur J Cardiovasc Prev Rehabil. 2003;10:336–344.PubMedCrossRef
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Metagegevens
Titel
Upstream therapy in patients with early atrial fibrillation
The relevance of the Routine versus Aggressive upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study
Auteurs
I.C. Van Gelder
M.D. Smit
M. Alings
H.J.G.M. Crijns
Publicatiedatum
01-11-2010
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 11/2010
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-010-0827-9