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Updated: Nov 1, 2025
The Isolation and Culture of Primary Epicardial Cells Derived from Human Adult and Fetal Heart Specimens
Published on: April 24, 2018
Epicardial origin of cardiac arrhythmias: clinical evidences and pathophysiology
Corentin Chaumont1,2, Nadine Suffee3, Estelle Gandjbakhch3
1Cardiology Department, Rouen University Hospital, Rouen, France.
Insights
The epicardial region is crucial for both ventricular and atrial arrhythmias, driven by structural changes like fibro-fatty infiltration. Understanding epicardial reactivation offers new therapeutic targets for heart rhythm disorders.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pathophysiology
Background:
- The epicardium plays a critical role in ventricular arrhythmias (e.g., Brugada syndrome, cardiomyopathies) and atrial fibrillation.
- Shared substrates include altered repolarization gradients and subepicardial fibro-fatty infiltration.
- Epicardial reactivation is increasingly recognized in arrhythmogenic substrate formation.
Purpose of the Study:
- To review the pathophysiological mechanisms of epicardial-driven arrhythmias.
- To highlight the role of epicardial progenitor cells and immune-inflammatory processes.
- To explore potential novel biomarkers and therapeutic strategies.
Main Methods:
- Review of recent literature on cardiac imaging, mapping, and ablation.
- Analysis of pathophysiological data linking epicardial alterations to arrhythmias.
- Synthesis of evidence on cellular and inflammatory contributions to arrhythmogenesis.
Main Results:
- Epicardial alterations are common to various ventricular and atrial arrhythmias.
- Epicardial progenitor cell recruitment and immune-inflammatory processes contribute to subepicardial fibrosis.
- Epicardial reactivation is a key factor in developing arrhythmogenic substrates.
Conclusions:
- The epicardium represents a critical 'electrical fragility' zone in the heart.
- Further understanding of epicardial mechanisms can lead to new diagnostic and therapeutic approaches for arrhythmias.
- Targeting epicardial pathways may offer novel treatment strategies for complex cardiac arrhythmias.
Abstract:
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 'electrical fragility' 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.
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