[Recent advances in the pathophysiology of atrial fibrillation]

This review is a summary of the pathophysiology of atrial fibrillation (AF) and the progress in the understanding of this arrhythmia. The following factors should be considered in the genesis and maintenance of AF. The genetic factor is involved in cases of familial AF. Predisposing structural factors: atrial dilation, structural feature that allows the development of AF. Predisposing structural factors: the role of the Bachmann's bundle and frequency gradients between the left and right atrium. Electrophysiological factors: heterogeneous refractory periods favor the fibrillatory conduction. Triggers: abnormal electrical activity (ectopic foci). Modulating factors: autonomic nervous system. Increased vagal tone shortens atrial refractory periods, creating a greater dispersion of the refractory periods and the generation of reentries in the context of triggered activity. Finally, there are three types of atrial remodeling secondary to AF: structural, contractile, electrical. They are interrelated and contribute to maintaining the AF ("AF begets AF").