Atrial fibrillation - mechanisms and mechanism-based treatment

Aims
To explore the mechanisms behind atrial fibrillation and to design treatment modalities based on this knowledge.

Project summary
Atrial fibrillation is the most common cardiac arrhythmia which necessitates treatment. It is almost as common as ischemic heart disease and is associated with sometimes advanced morbidity and significantly increased mortality. The mechanisms responsible for the initiation and perpetuation of the arrhythmia are incompletely understood. Our research aims at identifying the basic underlying mechanisms responsible for the development of the arrhythmia and applying this knowledge in new treatment modalities.

The exploration of arrhythmia mechanisms is done with in vitro techniques, animal studies as well as invasive and non-invasive techniques in patients.

The research program was initiated around 1992 as a research education program for PhD students.

Today, January 2008, 13 PhD programs have been reported. The program continues with ongoing PhD programs in addition to some projects outside the PhD education.

Using computer-based mathematical algorithms, we have revealed the seemingly chaotic behaviour of atrial myocardial excitation during the arrhythmia to be non-random and we have identified routes of preferential intra-atrial conduction. Genuine non-invasive electrophysiological methods have been developed and contribute to localising the pathoelectrophysiological mechanism involved in the transfer from normal excitation to fibrillation. Clinical intervention studies are used for identifying the possible reversibility of verified pathoelectrophysiological mechanism.

We have identified several earlier unknown mechanisms involved in the initial deterioration from sinus rhythm to atrial fibrillation and the perpetuation of the arrhythmia. This knowledge is likely to contribute not only to a better understanding of the arrhythmia but also to improved treatment, likely to result in decreased morbidity and mortality in this common disorder.

Following the retirement of the project leader in 2007 project responsibility is successively transferred to collaborators.

Co-workers
Project leader:
S Bertil Olsson, MD, PhD, Professor Emeritus

PhD students:
Andreas Bollman, MD
Anders Hansson, MD
Rasmus Havmöller, MD
Daniela Husser, MD
Carl-Johan Lindholm, MD

Collaborators:
Lund University:
Shiwen Yuan, MD, PhD
Carl Meurling, MD, PhD
Pyotr Platonov, MD, PhD
Jonas Carlson, MSc, PhD
Bjarne Madsen Härdig, RN, PhD
Rolf Johansson, MD, MSc, PhD, Professor
Leif Sörnmo, MSc, PhD. Professor
Torkel Wadström, MD, PhD. Professor
Åsa Ljungh, MD, PhD

David Cannom, MD, Medical Director of Cardiology, Good Samaritian Hospital, Los Angeles, USA

Staff
Monica Magnusson, Research Administrator
Birgit Smideberg, Medical Laboratory Technologist

Selected publications (PhD reports)
Magnus Holm: Chronic atrial fibrillation in man. Activation, organisation and characterisation. 1997
Steen Pehrson: The oesophageal route in clinical electrocardiology. 1998
Max Ingemansson: Cellular electrophysiological modulation in chronic atrial fibrillation. Studies with magnesium and GIK solution. 1998.
Anders Roijer:The role of transesophageal echocardiography in clinical decision-making in patients with stroke or atrial fibrillation. 2000.
Carl Meurling: Atrial Fibrillation. Modulation of the atrial fibrillatory frequency. A non-invasive approach. 2000.
Pyotr Platonov: The role of interatrial conduction in paroxysmal atrial fibrillation. From anatomy to electrophysiology. 2001.
Shaowen Liu: Atrioventricular conduction in patients with paroxysmal supraventricular tachycardia. 2003.
Martin Stridh: Signal characterization of atrial arrhythmias using the surface ECG. 2003.
Zhen Li: Sequence and dispersion of repolarization of the right atrium. Implications of repolarization disturbance in the genesis and/or perpetuation of atrial fibrillation. 2004.
Jonas Carlson: Exploration of Supraventricular Conduction with respect to Atrial Fibrillation. 2005.
Bjarne Madsen Härdig: Ultrasound-enhanced fibrinolysis . A study of pro-fibrinolytic effects and non-beneficial effects from ultrasound exposure. 2005.
Eva Hertervig: Conduction disturbances in patients with atrial fibrillation. 2006.
Fredrik Holmqvist: Characterisation of atrial electrophysiology with respect to atrial fibrillation. 2007.

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