Electrophysiological Consequences of Cardiac Fibrosis

For both the atria and ventricles, fibrosis is generally recognized as one of the key determinants of conduction disturbances. By definition, fibrosis refers to an increased amount of fibrous tissue. However, fibrosis is not a singular entity. Various forms can be distinguished, that differ in distr...

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Main Authors: Sander Verheule, Ulrich Schotten
Format: Article
Language:English
Published: MDPI AG 2021-11-01
Series:Cells
Subjects:
Online Access:https://www.mdpi.com/2073-4409/10/11/3220
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author Sander Verheule
Ulrich Schotten
author_facet Sander Verheule
Ulrich Schotten
author_sort Sander Verheule
collection DOAJ
description For both the atria and ventricles, fibrosis is generally recognized as one of the key determinants of conduction disturbances. By definition, fibrosis refers to an increased amount of fibrous tissue. However, fibrosis is not a singular entity. Various forms can be distinguished, that differ in distribution: replacement fibrosis, endomysial and perimysial fibrosis, and perivascular, endocardial, and epicardial fibrosis. These different forms typically result from diverging pathophysiological mechanisms and can have different consequences for conduction. The impact of fibrosis on propagation depends on exactly how the patterns of electrical connections between myocytes are altered. We will therefore first consider the normal patterns of electrical connections and their regional diversity as determinants of propagation. Subsequently, we will summarize current knowledge on how different forms of fibrosis lead to a loss of electrical connectivity in order to explain their effects on propagation and mechanisms of arrhythmogenesis, including ectopy, reentry, and alternans. Finally, we will discuss a histological quantification of fibrosis. Because of the different forms of fibrosis and their diverging effects on electrical propagation, the total amount of fibrosis is a poor indicator for the effect on conduction. Ideally, an assessment of cardiac fibrosis should exclude fibrous tissue that does not affect conduction and differentiate between the various types that do; in this article, we highlight practical solutions for histological analysis that meet these requirements.
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spelling doaj.art-5cf7b3733fc34b5daa801b81eb39769f2023-11-22T22:53:03ZengMDPI AGCells2073-44092021-11-011011322010.3390/cells10113220Electrophysiological Consequences of Cardiac FibrosisSander Verheule0Ulrich Schotten1Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, 6200 MD Maastricht, The NetherlandsDepartment of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, 6200 MD Maastricht, The NetherlandsFor both the atria and ventricles, fibrosis is generally recognized as one of the key determinants of conduction disturbances. By definition, fibrosis refers to an increased amount of fibrous tissue. However, fibrosis is not a singular entity. Various forms can be distinguished, that differ in distribution: replacement fibrosis, endomysial and perimysial fibrosis, and perivascular, endocardial, and epicardial fibrosis. These different forms typically result from diverging pathophysiological mechanisms and can have different consequences for conduction. The impact of fibrosis on propagation depends on exactly how the patterns of electrical connections between myocytes are altered. We will therefore first consider the normal patterns of electrical connections and their regional diversity as determinants of propagation. Subsequently, we will summarize current knowledge on how different forms of fibrosis lead to a loss of electrical connectivity in order to explain their effects on propagation and mechanisms of arrhythmogenesis, including ectopy, reentry, and alternans. Finally, we will discuss a histological quantification of fibrosis. Because of the different forms of fibrosis and their diverging effects on electrical propagation, the total amount of fibrosis is a poor indicator for the effect on conduction. Ideally, an assessment of cardiac fibrosis should exclude fibrous tissue that does not affect conduction and differentiate between the various types that do; in this article, we highlight practical solutions for histological analysis that meet these requirements.https://www.mdpi.com/2073-4409/10/11/3220fibrosisconductionarrhythmiastissue structureheart
spellingShingle Sander Verheule
Ulrich Schotten
Electrophysiological Consequences of Cardiac Fibrosis
Cells
fibrosis
conduction
arrhythmias
tissue structure
heart
title Electrophysiological Consequences of Cardiac Fibrosis
title_full Electrophysiological Consequences of Cardiac Fibrosis
title_fullStr Electrophysiological Consequences of Cardiac Fibrosis
title_full_unstemmed Electrophysiological Consequences of Cardiac Fibrosis
title_short Electrophysiological Consequences of Cardiac Fibrosis
title_sort electrophysiological consequences of cardiac fibrosis
topic fibrosis
conduction
arrhythmias
tissue structure
heart
url https://www.mdpi.com/2073-4409/10/11/3220
work_keys_str_mv AT sanderverheule electrophysiologicalconsequencesofcardiacfibrosis
AT ulrichschotten electrophysiologicalconsequencesofcardiacfibrosis