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Comparisons of Substrates Responsible for Atrial Versus Ventricular Fibrillation

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Electrical Diseases of the Heart

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Abstract

The fundamental mechanisms underlying fibrillation have long been debated. The classical notion of multiple circuit reentry has been challenged by recent ideas suggesting that in some cases a single high-frequency rotor or even a rapidly-firing focus can underlie fibrillation that can cause wave breakup and fibrillation. There is increasing awareness that arrhythmias do not usually begin in perfectly normal tissue, but require changes in tissue structure or function that constitute the arrhythmic substrate. In this chapter, atrial and ventricular changes (including alterations in ion channel function, intercellular coupling, and fibrosis) playing a role in fibrillation are reviewed. We focus particularly on ischemic substrates, congestive heart failure remodeling, genetic factors, neuroregulatory determinants, and arrhythmic remodeling. Atrial (AF) and ventricular (VF) fibrillation-substrates have many features in common but also a number of important specific differences. Consideration of these mechanistic determinants will lead to improved understanding of the pathophysiology of AF and VF, and ultimately to improve arrhythmia-specific therapeutic approaches.

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Acknowledgement.

Supported by the “Fond de Recherche en Santé du Québec”, the Natural Sciences and Engineering Research Council, the Canadian Institutes of Health Research, and the Mathematics of Information Technology and Complex Systems Network of Centers of Excellence.

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Authors and Affiliations

  1. Department of Physiology, Institute of Biomedical Engineering, Université de Montréal, Montreal, QC, Canada

    Philippe Comtois PhD

  2. Research Centre, Montreal Heart Institute, 5000 Belanger, Montreal, QC, H1T 1C8, Canada

    Philippe Comtois PhD, Brett Burstein MD, PhD & Stanley Nattel MD

  3. Department of Medicine, Université de Montréal, Montreal, QC, Canada

    Stanley Nattel MD

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  1. Philippe Comtois PhD
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  2. Brett Burstein MD, PhD
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  3. Stanley Nattel MD
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Correspondence to Philippe Comtois PhD .

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  1. , Department of Internal Medicine, UMDNJ-RWJ Medical School, Robert Wood Johnson Pl. 1, New Brunswick, 08903-0019, New Jersey, USA

    Ihor Gussak

  2. , Gordon K. Moe Scholar, Masonic Medical Research Laboratory, Bleecker Street, Utica, 13501-1787, New York, USA

    Charles Antzelevitch

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Comtois, P., Burstein, B., Nattel, S. (2013). Comparisons of Substrates Responsible for Atrial Versus Ventricular Fibrillation. In: Gussak, I., Antzelevitch, C. (eds) Electrical Diseases of the Heart. Springer, London. https://doi.org/10.1007/978-1-4471-4881-4_20

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