The associations between multiple circulating biomarkers and the occurrence of atrial fibrillation in hypertrophic cardiomyopathy with or without left ventricular outflow tract obstruction

Objective Atrial fibrillation(AF)is the most common arrhythmia that can portend adverse prognosis in patients with hypertrophic cardiomyopathy(HCM).Data regarding the correlations of different biomarkers and AF in HCM patients are rather limited.In this study,we sought to explore the associations between the occurrence of AF and circulating biomarkers reflecting cardiovascular function(N-terminal pro-Brain natriuretic peptide,NT-proBNP),endothelial function(big endothenlin-1,big ET-1),inflammation(high-sensitivity C-reactive protein,hs-CRP)and myocardial damage(cardiac troponin I,cTnI)in HCM patients with or without left ventricular outflow tract obstruction(LVOTO),respectively.

Atrial fibrillation:mechanism and clinical management

Atrial fibrillation(AF),the most common sustained arrhythmia,is associated with a range of symptoms,including palpitations,cognitive impairment,systemic embolism,and increased mortality.It places a significant burden on healthcare systems worldwide.Despite decades of research,the precise mechanisms underlying AF remain elusive.Current understanding suggests that factors like stretch-induced fibrosis,epicardial adipose tissue(EAT),chronic inflammation,autonomic nervous system(ANS)imbalances,and genetic mutations all play significant roles in its development.In recent years,the advent of wearable devices has revolutionized AF diagnosis,enabling timely detection and monitoring.However,balancing early diagnosis with efficient resource utilization presents new challenges for healthcare providers.AF management primarily focuses on stroke prevention and symptom alleviation.Patients at high risk of thromboembolism require anticoagulation therapy,and emerging pipeline drugs,particularly factor XI inhibitors,hold promise for achieving effective anticoagulation with reduced bleeding risks.The scope of indications for catheter ablation in AF has expanded significantly.Pulsed field ablation,as a novel energy source,shows potential for improving success rates while ensuring safety.This review integrates existing knowledge and ongoing research on AF pathophysiology and clinical management,with emphasis on diagnostic devices,next-generation anticoagulants,drugs targeting underlying mechanisms,and interventional therapies.It offers a comprehensive mosaic of AF,providing insights into its complexities.