Go to JCI Insight
  • About
  • Editors
  • Consulting Editors
  • For authors
  • Publication ethics
  • Publication alerts by email
  • Advertising
  • Job board
  • Contact
  • Clinical Research and Public Health
  • Current issue
  • Past issues
  • By specialty
    • COVID-19
    • Cardiology
    • Gastroenterology
    • Immunology
    • Metabolism
    • Nephrology
    • Neuroscience
    • Oncology
    • Pulmonology
    • Vascular biology
    • All ...
  • Videos
    • Conversations with Giants in Medicine
    • Video Abstracts
  • Reviews
    • View all reviews ...
    • Complement Biology and Therapeutics (May 2025)
    • Evolving insights into MASLD and MASH pathogenesis and treatment (Apr 2025)
    • Microbiome in Health and Disease (Feb 2025)
    • Substance Use Disorders (Oct 2024)
    • Clonal Hematopoiesis (Oct 2024)
    • Sex Differences in Medicine (Sep 2024)
    • Vascular Malformations (Apr 2024)
    • View all review series ...
  • Viewpoint
  • Collections
    • In-Press Preview
    • Clinical Research and Public Health
    • Research Letters
    • Letters to the Editor
    • Editorials
    • Commentaries
    • Editor's notes
    • Reviews
    • Viewpoints
    • 100th anniversary
    • Top read articles

  • Current issue
  • Past issues
  • Specialties
  • Reviews
  • Review series
  • Conversations with Giants in Medicine
  • Video Abstracts
  • In-Press Preview
  • Clinical Research and Public Health
  • Research Letters
  • Letters to the Editor
  • Editorials
  • Commentaries
  • Editor's notes
  • Reviews
  • Viewpoints
  • 100th anniversary
  • Top read articles
  • About
  • Editors
  • Consulting Editors
  • For authors
  • Publication ethics
  • Publication alerts by email
  • Advertising
  • Job board
  • Contact
Recent advances in the molecular pathophysiology of atrial fibrillation
Reza Wakili, … , Dobromir Dobrev, Stanley Nattel
Reza Wakili, … , Dobromir Dobrev, Stanley Nattel
Published August 1, 2011
Citation Information: J Clin Invest. 2011;121(8):2955-2968. https://doi.org/10.1172/JCI46315.
View: Text | PDF
Science in Medicine

Recent advances in the molecular pathophysiology of atrial fibrillation

  • Text
  • PDF
Abstract

Atrial fibrillation (AF) is an extremely common cardiac rhythm disorder that causes substantial morbidity and contributes to mortality. The mechanisms underlying AF are complex, involving both increased spontaneous ectopic firing of atrial cells and impulse reentry through atrial tissue. Over the past ten years, there has been enormous progress in understanding the underlying molecular pathobiology. This article reviews the basic mechanisms and molecular processes causing AF. We discuss the ways in which cardiac disease states, extracardiac factors, and abnormal genetic control lead to the arrhythmia. We conclude with a discussion of the potential therapeutic implications that might arise from an improved mechanistic understanding.

Authors

Reza Wakili, Niels Voigt, Stefan Kääb, Dobromir Dobrev, Stanley Nattel

×

Figure 1

ECG recordings of sinus rhythm and AF.

Options: View larger image (or click on image) Download as PowerPoint
ECG recordings of sinus rhythm and AF.
(A) Bottom: A normal ECG recordin...
(A) Bottom: A normal ECG recording showing sinus rhythm. Top: Schematics of major events in one cardiac activation cycle: rhythm is initiated by the SA node pacemaker, resulting in atrial activation, followed by atrioventricular conduction via the AV node and His-Purkinje conducting system, leading to ventricular activation. (B) ECG showing onset of AF after one regular sinus beat. Atrial activation is now rapid and irregular, producing an undulating baseline that is visible when not obscured by larger QRS and T waves (continuous atrial activity during this phase is represented by dotted lines). During AF, rapid and uncoordinated atrial activity leads to ineffective atrial contraction. Ventricular activations (QRS complexes) now driven by the fibrillating atria occur rapidly and irregularly, weakening cardiac contraction efficiency and causing clinical symptoms.

Copyright © 2025 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

Sign up for email alerts