The Many Faces of the AF Substrate-The Many Faces of the AF Substrate

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Video Summary

The session at the University of Washington focused on the complex substrate of atrial fibrillation (AFib) from electrical, metabolic, and structural points of view. Dr. Yogi Swaran emphasized the role of cardiac magnetic resonance (CMR) in understanding atrial myopathy and its connection to AFib and related complications like stroke and heart failure. The UK Biobank provided significant data, revealing associations of atrial structure and function with various cardiovascular risks.<br /><br />Romano Saikal from the University of Washington talked about metabolic shifts relating to AFib, highlighting that inflammatory changes observed via PET imaging are indicative of AFib. His findings suggest that atrial metabolic activity and PET imaging can guide AFib management strategies.<br /><br />Dr. Jonathan Kalman discussed the interplay between obesity, epicardial fat, and AFib. He showed that epicardial adipose tissue is more strongly associated with AFib risk than body mass index alone. His research suggested that weight loss and risk factor management can reverse electrical and structural changes in the atria, highlighting the potential for AFib phenotype reversibility with lifestyle changes.<br /><br />John Barnard then presented on myocardial metabolomics, showing that metabolic enzyme changes correspond with AFib progression. He noted a decrease in glycolysis and an increase in fatty acid utilization as AFib worsens.<br /><br />Finally, Dr. Ahmed Kassab focused on oxygen consumption and AFib symptoms, revealing that patients in AFib rhythm exhibit higher myocardial oxygen extraction, correlating with fatigue and exercise intolerance. This work introduces the potential for targeting metabolism as part of AFib management.<br /><br />Overall, the session underscored the multifaceted nature of AFib, advocating for more personalized and multidisciplinary approaches in managing the condition.

Keywords

atrial fibrillation

cardiac magnetic resonance

atrial myopathy

UK Biobank

metabolic shifts

PET imaging

epicardial fat

obesity

myocardial metabolomics

oxygen consumption

personalized management