Diastolic dysfunction and atrial fibrillation in coronary heart disease surgery: A literature review

Abstract

Diastolic dysfunction can cause atrial fibrillation through the following mechanisms: increased atrial afterload, atrial stretch, and atrial wall pressure due to dilatation. Diastolic dysfunction is often overlooked in coronary heart disease than systolic (left ventricular) function, even though diastolic dysfunction can also result in significant morbidity and mortality. Diastolic dysfunction is an independent predictor of atrial fibrillation. Diastolic dysfunction enlarges the left atrium, stretches the insertion site for pulmonary veins, and initiates atrial fibrillation. Atrial remodelling in atrial fibrillation and diastolic dysfunction progresses from metabolic changes (phosphorylation) to gene expression changes (calcium channel downregulation) to hibernation (myolysis, de-differentiation) and culminates in irreversible changes (fatty changes).