{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:55:08Z","timestamp":1792205708087,"version":"4.4.0"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Scientific research on atrial fibrosis in atrial fibrillation (AF) has mainly focused on quantitative or molecular features. The purpose of this study was to perform a clinicoarchitectural\/structural investigation of fibrosis to provide one key to understanding the electrophysiological\/clinical aspects of AF.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We characterized the fibrosis (amount, architecture, cellular components, and ultrastructure) in left atrial biopsies from 121 patients with persistent\/long-lasting persistent AF (group 1; 59 males; 60\u00b111 years; 91 mitral disease\u2013related AF, 30 nonmitral disease\u2013related AF) and from 39 patients in sinus rhythm with mitral valve regurgitation (group 2; 32 males; 59\u00b112 years). Ten autopsy hearts served as controls.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Qualitatively, the fibrosis exhibited the same characteristics in all cases and displayed particular architectural scenarios (which we arbitrarily subdivided into 4 stages) ranging from isolated foci to confluent sclerotic areas. The percentage of fibrosis was larger and at a more advanced stage in group 1 versus group 2 and, within group 1, in patients with rheumatic disease versus nonrheumatic cases. In patients with AF with mitral disease and no rheumatic disease, the percentage of fibrosis and the fibrosis stages correlated with both left atrial volume index and AF duration. The fibrotic areas mainly consisted of type I collagen with only a minor cellular component (especially fibroblasts\/myofibroblasts; average value range 69\u2013150 cells\/mm\n              <jats:sup>2<\/jats:sup>\n              , depending on the areas in AF biopsies). A few fibrocytes\u2014circulating and bone marrow-derived mesenchymal cells\u2014were also detectable. The fibrosis-entrapped cardiomyocytes showed sarcolemmal damage and connexin 43 redistribution\/internalization.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Atrial fibrosis is an evolving and inhomogeneous histological\/architectural change that progresses through different stages ranging from isolated foci to confluent sclerotic zones which\u2014seemingly\u2014constrain impulse conduction across restricted regions of electrotonically coupled cardiomyocytes. The fibrotic areas mainly consist of type I collagen extracellular matrix and, only to a lesser extent, mesenchymal cells.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.119.007588","type":"journal-article","created":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T05:15:08Z","timestamp":1592198108000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Clinicopathological Bird\u2019s-Eye View of Left Atrial Myocardial Fibrosis in 121 Patients With Persistent Atrial Fibrillation"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0947-4862","authenticated-orcid":true,"given":"Sergio","family":"Callegari","sequence":"first","affiliation":[{"name":"Center of Excellence for Toxicological Research (CERT) (S.C.), University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8993-3987","authenticated-orcid":true,"given":"Emilio","family":"Macchi","sequence":"additional","affiliation":[{"name":"Department of Chemistry, Life Sciences and Environmental Sustainability (E.M., L.M., V.G.), University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolfo","family":"Monaco","sequence":"additional","affiliation":[{"name":"Pathology Unit (R.M., A.T., G.B., E.C., D.C.), Department of Medicine and Surgery, University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9200-679X","authenticated-orcid":true,"given":"Luca","family":"Magnani","sequence":"additional","affiliation":[{"name":"Department of Chemistry, Life Sciences and Environmental Sustainability (E.M., L.M., V.G.), University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0183-757X","authenticated-orcid":true,"given":"Alessandro","family":"Tafuni","sequence":"additional","affiliation":[{"name":"Pathology Unit (R.M., A.T., G.B., E.C., D.C.), Department of Medicine and Surgery, University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Croci","sequence":"additional","affiliation":[{"name":"Clinical Immunology, Allergy &amp; Advanced Biotechnologies Unit, Azienda Unit\u00e0, Sanitaria Locale-IRCCS, Reggio Emilia, Italy (S.C., M.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Nicastro","sequence":"additional","affiliation":[{"name":"Clinical Immunology, Allergy &amp; Advanced Biotechnologies Unit, Azienda Unit\u00e0, Sanitaria Locale-IRCCS, Reggio Emilia, Italy (S.C., M.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9716-7699","authenticated-orcid":true,"given":"Valentina","family":"Garrapa","sequence":"additional","affiliation":[{"name":"Department of Chemistry, Life Sciences and Environmental Sustainability (E.M., L.M., V.G.), University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Banchini","sequence":"additional","affiliation":[{"name":"Forensic Medicine Unit (A.B.), Department of Medicine and Surgery, University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Becchi","sequence":"additional","affiliation":[{"name":"Pathology Unit (R.M., A.T., G.B., E.C., D.C.), Department of Medicine and Surgery, University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Corradini","sequence":"additional","affiliation":[{"name":"Pathology Unit (R.M., A.T., G.B., E.C., D.C.), Department of Medicine and Surgery, University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1342-3921","authenticated-orcid":true,"given":"Matteo","family":"Goldoni","sequence":"additional","affiliation":[{"name":"Laboratory of Industrial Toxicology (M.G.), Department of Medicine and Surgery, University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2145-2642","authenticated-orcid":true,"given":"Francesca","family":"Rocchio","sequence":"additional","affiliation":[{"name":"International Centre for T1D, Paediatric Clinical Research Center Fondazione \u201cRomeo ed Enrica Invernizzi\u201d, Department of Biomedical &amp; Clinical Science, Hospital \u201cL. Sacco\u201d, University of Milan, Italy (F.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9167-0020","authenticated-orcid":true,"given":"Roberto","family":"Sala","sequence":"additional","affiliation":[{"name":"General Pathology Unit (R.S.), Department of Medicine and Surgery, University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Benussi","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Spedali Civili, Brescia, Italy (S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0029-1816","authenticated-orcid":true,"given":"David","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery Unit, Department of Cardiology, San Raffaele University Hospital, Milan, Italy (D.F., O.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1065-8052","authenticated-orcid":true,"given":"Ottavio","family":"Alfieri","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery Unit, Department of Cardiology, San Raffaele University Hospital, Milan, Italy (D.F., O.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8836-4778","authenticated-orcid":true,"given":"Domenico","family":"Corradi","sequence":"additional","affiliation":[{"name":"Pathology Unit (R.M., A.T., G.B., E.C., D.C.), Department of Medicine and Surgery, University of Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.05.028"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.carpath.2013.12.001"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardiores.2004.03.026"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/ncpcardio1370"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2017.03.002"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00025.2003"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1010-7940(00)00391-2"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2005.07.018"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-004-1040-2"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2007.12.007"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2011.02187.x"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.02.008"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2017.05.34"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2010.01887.x"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.107.760447"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2012.08.043"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2005.087171"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0008-6363(02)00251-1"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eum206"},{"key":"e_1_3_5_21_2","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/B978-0-12-420219-1.00012-4","volume-title":"In: Cardiovascular Pathology","author":"Vaideeswar P","year":"2016","unstructured":"Vaideeswar, P, Butany, J. 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