Atrial Remodeling in Permanent Atrial Fibrillation: Mechanisms and Pharmacological Implications

Abstract

Atrial fibrillation (AF), the most prevalent rhythm disorder in clinical practice, is currently significantly contributing to morbidity and mortality of the ageing population. In the past decades, a tremendous amount of research resulted in valuable insights into AF pathophysiology, with a primary focus on atrial remodeling. Defined as a persistent change in atrial function and structure, remodeling has the intrinsic properties to enhance the probability of focal (ectopic) and/or re-entrant pursuits, thus supporting AF persistence. The hallmark of structural remodeling is represented by atrial fibrosis, a multifactorial process involving an interaction between neurohormonal and cellular mediators. This paper provides a brief summary of the recent knowledge with respect to electrical and structural remodeling and novel insights into the pathogenesis of atrial fibrosis. Since current drug options for AF treatment are far from being optimal we also discuss the therapeutic principles and current alternatives for counteracting atrial fibrosis, and thus preventing arrhythmia recurrence.

Looking for new frontiers in atrial fibrillation ablation. A remaining challenge for health care

“…6,7 More advanced AF is, therefore, more difficult to treat with simple catheter ablation. Nevertheless, around 40% of the procedures performed are reported to be for patients with persistent type of AF.…”

Looking for new frontiers in atrial fibrillation ablation. A remaining challenge for health care

“…5 Differences in the success rates are likely E-mail address: m.martinsoliveira@gmail.com related to a more complex substrate in persistent (and long-standing persistent) AF, and with the fact that the electrical, autonomic and structural changes related to the atrial remodeling phenomena promote the maintenance of AF, contributing to the resistance to sinus rhythm conversion and to AF recurrences. 6,7 More advanced AF is, therefore, more difficult to treat with simple catheter ablation. Nevertheless, around 40% of the procedures performed are reported to be for patients with persistent type of AF.…”