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Author: Admin | 2025-04-28
Of AF. In dilated atria, multiple circuits coexist. Fibrosis leads to inhomogeneities in conduction and refractoriness and the arrhythmia itself causes persistent shortening of refractoriness. All of these changes favour re-entry.11 Mitral regurgitationMitral regurgitation is common in HF, with different underlying etiologies for HFrEF and HFpEF. In HFrEF, structural ventricular remodelling and LV dilatation may lead to secondary mitral regurgitation, whereas HFpEF may induce atrial functional mitral regurgitation predominantly due to annular dilatation and anterior leaflet flattening.12 Moderate or severe mitral regurgitation causes left atrial volume and pressure overload, resulting in increased local atrial wall stress, thus promoting the development of AF. The severity of regurgitation is correlated with the development of AF. Notably, AF itself may cause atrial functional mitral regurgitation similar to the manner in which HFpEF does, thereby indirectly sustaining itself. Neurohumoral changes in heart failureThe decreased cardiac output during acute and chronic HF, similarly to that during AF, often causes RAAS and sympathetic activation. Besides their impact on HF development, these neurohumoral changes promote atrial remodelling and increase susceptibility for AF as well. The structural myocardial changes in the atria following increased RAAS hormone levels lead to increased development and sustenance of AF. Furthermore, sympathetic stimulation causes increased early and delayed afterdepolarizations, increased focal firing and favourable conditions for re-entry, thus increasing the susceptibility for AF.13 Importantly, as these neurohumoral changes are both a cause of and a result from AF as well as HF, a continuous process is created in which the presence of (one of) the diseases may provoke or deteriorate both itself and the other. Mutual risk factorsAdditionally, AF and HF share a common risk profile, increasing the possibility of developing both conditions separately from each other. Both HF and AF are more commonly seen in older patients with cardiovascular risk factors such
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