{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:09:18Z","timestamp":1790698158578,"version":"4.1.0"},"reference-count":104,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,6,21]],"date-time":"2021-06-21T00:00:00Z","timestamp":1624233600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"French National Agency"},{"name":"Investissements d\u2019Avenir","award":["ANR-10-IAHU-05"],"award-info":[{"award-number":["ANR-10-IAHU-05"]}]},{"name":"Investissements d\u2019Avenir","award":["ANR-15-RHUS-0003"],"award-info":[{"award-number":["ANR-15-RHUS-0003"]}]},{"name":"Fondation de La Recherche Medicale"},{"name":"European Union\u2019s Horizon 2020 research and innovation programme","award":["965286"],"award-info":[{"award-number":["965286"]}]},{"name":"MAESTRIA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Recent developments in imaging, mapping, and ablation techniques have shown that the epicardial region of the heart is a key player in the occurrence of ventricular arrhythmic events in several cardiac diseases, such as Brugada syndrome, arrhythmogenic cardiomyopathy, or dilated cardiomyopathy. At the atrial level as well, the epicardial region has emerged as an important determinant of the substrate of atrial fibrillation, pointing to common underlying pathophysiological mechanisms. Alteration in the gradient of repolarization between myocardial layers favouring the occurrence of re-entry circuits has largely been described. The fibro-fatty infiltration of the subepicardium is another shared substrate between ventricular and atrial arrhythmias. Recent data have emphasized the role of the epicardial reactivation in the formation of this arrhythmogenic substrate. There are new evidences supporting this structural remodelling process to be regulated by the recruitment of epicardial progenitor cells that can differentiate into adipocytes or fibroblasts under various stimuli. In addition, immune-inflammatory processes can also contribute to fibrosis of the subepicardial layer. A better understanding of such \u2018electrical fragility\u2019 of the epicardial area will open perspectives for novel biomarkers and therapeutic strategies. In this review article, a pathophysiological scheme of epicardial-driven arrhythmias will be proposed.<\/jats:p>","DOI":"10.1093\/cvr\/cvab213","type":"journal-article","created":{"date-parts":[[2021,6,18]],"date-time":"2021-06-18T19:13:07Z","timestamp":1624043587000},"page":"1693-1702","source":"Crossref","is-referenced-by-count":31,"title":["Epicardial origin of cardiac arrhythmias: clinical evidences and pathophysiology"],"prefix":"10.1093","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7188-2686","authenticated-orcid":false,"given":"Corentin","family":"Chaumont","sequence":"first","affiliation":[{"name":"Cardiology Department, Rouen University Hospital , Rouen , France"},{"name":"FHU REMOD-VHF, UNIROUEN , INSERM U1096, F76000 Rouen , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9277-5089","authenticated-orcid":false,"given":"Nadine","family":"Suffee","sequence":"additional","affiliation":[{"name":"INSERM UMRS1166, ICAN\u2014Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Piti\u00e9-Salp\u00eatri\u00e8re Hospital , 91, boulevard de l\u2019h\u00f4pital, 75013 Paris , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estelle","family":"Gandjbakhch","sequence":"additional","affiliation":[{"name":"INSERM UMRS1166, ICAN\u2014Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Piti\u00e9-Salp\u00eatri\u00e8re Hospital , 91, boulevard de l\u2019h\u00f4pital, 75013 Paris , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5224-9180","authenticated-orcid":false,"given":"Elise","family":"Balse","sequence":"additional","affiliation":[{"name":"INSERM UMRS1166, ICAN\u2014Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Piti\u00e9-Salp\u00eatri\u00e8re Hospital , 91, boulevard de l\u2019h\u00f4pital, 75013 Paris , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2130-9790","authenticated-orcid":false,"given":"Fr\u00e9d\u00e9ric","family":"Anselme","sequence":"additional","affiliation":[{"name":"Cardiology Department, Rouen University Hospital , Rouen, France"},{"name":"FHU REMOD-VHF, UNIROUEN , INSERM U1096, F76000 Rouen , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9790-0755","authenticated-orcid":false,"given":"St\u00e9phane N","family":"Hatem","sequence":"additional","affiliation":[{"name":"INSERM UMRS1166, ICAN\u2014Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Piti\u00e9-Salp\u00eatri\u00e8re Hospital , 91, boulevard de l\u2019h\u00f4pital, 75013 Paris , France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,6,21]]},"reference":[{"key":"2022062212370087500_cvab213-B1","doi-asserted-by":"crossref","first-page":"e005053","DOI":"10.1161\/CIRCEP.117.005053","article-title":"Electrical substrate elimination in 135 consecutive patients with Brugada syndrome","volume":"10","author":"Pappone","year":"2017","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2022062212370087500_cvab213-B2","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1161\/CIRCULATIONAHA.108.834903","article-title":"Epicardial substrate and outcome with epicardial ablation of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy\/dysplasia","volume":"120","author":"Garcia","year":"2009","journal-title":"Circulation"},{"key":"2022062212370087500_cvab213-B3","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1016\/j.jacc.2009.10.084","article-title":"Epicardial ventricular tachycardia ablation: a multicenter safety study","volume":"55","author":"Sacher","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"2022062212370087500_cvab213-B4","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1161\/CIRCRESAHA.111.259960","article-title":"Endocardial and epicardial epithelial to mesenchymal transitions in heart development and disease","volume":"110","author":"von","year":"2012","journal-title":"Circ Res"},{"key":"2022062212370087500_cvab213-B5","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1006\/dbio.1997.8801","article-title":"Common epicardial origin of coronary vascular smooth muscle, perivascular fibroblasts, and intermyocardial fibroblasts in the avian heart","volume":"193","author":"Dettman","year":"1998","journal-title":"Dev Biol"},{"key":"2022062212370087500_cvab213-B6","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1002\/(SICI)1097-0185(19990601)255:2<212::AID-AR11>3.0.CO;2-X","article-title":"Does the subepicardial mesenchyme contribute myocardioblasts to the myocardium of the chick embryo heart? 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