Heart failure differentially modulates natural (Sinoatrial node) and ectopic (pulmonary veins) pacemakers: Mechanism and therapeutic implication for atrial fibrillation

Chao Shun Chan, Yung Kuo Lin, Yao Chang Chen, Yen Yu Lu, Shih Ann Chen, Yi Jen Chen

Research output: Contribution to journalReview article

1 Citation (Scopus)


Heart failure (HF) frequently coexists with atrial fibrillation (AF) and dysfunction of the sinoatrial node (SAN), the natural pacemaker. HF is associated with chronic adrenergic stimulation, neurohormonal activation, abnormal intracellular calcium handling, elevated cardiac filling pressure and atrial stretch, and fibrosis. Pulmonary veins (PVs), which are the points of onset of ectopic electrical activity, are the most crucial AF triggers. A crosstalk between the SAN and PVs determines PV arrhythmogenesis. HF has different effects on SAN and PV electrophysiological characteristics, which critically modulate the development of AF and sick sinus syndrome. This review provides updates to improve our current understanding of the effects of HF in the electrical activity of the SAN and PVs as well as therapeutic implications for AF.

Original languageEnglish
Article number3224
JournalInternational Journal of Molecular Sciences
Issue number13
Publication statusPublished - Jul 1 2019



  • Atrial fibrillation
  • Heart failure
  • Pulmonary veins
  • Sinoatrial node
  • Sinoatrial node dysfunction

ASJC Scopus subject areas

  • Catalysis
  • Molecular Biology
  • Spectroscopy
  • Computer Science Applications
  • Physical and Theoretical Chemistry
  • Organic Chemistry
  • Inorganic Chemistry

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