Atrial Fibrillation and Chronic Coronary Ischemia: A Challenging Vicious Circle

Atrial fibrillation, the most frequent arrhythmia in clinical practice and chronic coronary syndrome, is one of the forms of coronary ischemia to have a strong dual relationship. Atrial fibrillation may accelerate atherosclerosis and may increase oxygen consumption in the myocardium, creating a mismatch between supply and demand, thus promoting the development or worsening of coronary ischemia. Chronic coronary syndrome alters the structure and function of gap junction proteins, affecting the conduction of action potential and leading to ischemic necrosis of cardiomyocytes and their replacement with fibrous tissue, in this way sustaining the focal ectopic activity in atrial myocardium. They have many risk factors in common, such as hypertension, obesity, type 2 diabetes mellitus, and dyslipidemia. It is vital for the prognosis of patients to break this vicious circle by controlling risk factors, drug therapies, of which antithrombotic therapy may sometimes be challenging in terms of prothrombotic and bleeding risk, and interventional therapies (revascularization and catheter ablation).

Automated summary

Atrial fibrillation and chronic coronary syndrome have a strong dual relationship, with atrial fibrillation potentially accelerating atherosclerosis and increasing myocardial oxygen consumption, leading to a mismatch between supply and demand and promoting the development or worsening of coronary ischemia. Chronic coronary syndrome alters the structure and function of gap junction proteins, impacting action potential conduction and sustaining focal ectopic activity in atrial myocardium. They share common risk factors such as hypertension, obesity, type 2 diabetes mellitus, and dyslipidemia. Breaking this vicious cycle through controlling risk factors, drug therapies (including antithrombotic therapy), and interventional therapies (revascularization and catheter ablation) is vital for patient prognosis.