© 2002 by European Society of Cardiology
Copyright © 2002, European Society of Cardiology
Electrical, contractile and structural remodeling during atrial fibrillation
Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
m.allessie{at}fys.unimaas.nl
* Corresponding author. Tel.: +31-43-388-1202/00; fax: +31-43-388-4166
The natural history of atrial fibrillation (AF) is characterized by a gradual worsening with time. The recent finding that AF itself produces changes in atrial function and structure has provided a possible explanation for the progressive nature of this arrhythmia. Electrical remodeling (shortening of atrial refractoriness) develops within the first days of AF and contributes to an increase in stability of AF. However, ‘domestication of AF’ must also depend on a ‘second factor’ since the persistence of AF continues to increase after electrical remodeling has been completed. Atrial contractile remodeling (loss of contractility) leads to a reduced atrial transport function after cardioversion of AF. An important clinical consequence is that during several days after restoration of sinus rhythm, the risk of atrial thrombus formation is still high. In addition, the reduction of atrial contractility during AF may enhance atrial dilatation which may add to the persistence of AF. Tachycardia-induced structural remodeling takes place in a different time domain (weeks to months). Myolysis probably contributes to the loss of atrial contractile force. Although it might explain the loss of efficacy of pharmacological cardioversion and the development of permanent AF, the role of structural remodeling in the progression of AF is still unclear. Atrial structural remodeling also occurs as a result of heart failure and other underlying cardiovascular diseases. The associated atrial fibrosis might explain intra-atrial conduction disturbances and the susceptibility for AF. Thus, both AF itself and the underlying heart disease are responsible for the development of the arrhythmogenic substrate. New strategies for prevention and termination of AF should be build on our knowledge of the mechanisms and time course of AF-induced atrial remodeling.
KEYWORDS Remodeling; Supraventr. arrhythmia
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P. Milliez, N. DeAngelis, C. Rucker-Martin, A. Leenhardt, E. Vicaut, E. Robidel, P. Beaufils, C. Delcayre, and S. N. Hatem Spironolactone reduces fibrosis of dilated atria during heart failure in rats with myocardial infarction Eur. Heart J., October 2, 2005; 26(20): 2193 - 2199. [Abstract] [Full Text] [PDF]
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W. Anne, R. Willems, T. Roskams, P. Sergeant, P. Herijgers, P. Holemans, H. Ector, and H. Heidbuchel Matrix metalloproteinases and atrial remodeling in patients with mitral valve disease and atrial fibrillation Cardiovasc Res, September 1, 2005; 67(4): 655 - 666. [Abstract] [Full Text] [PDF]
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D. J. Milan and C. A. MacRae Animal models for arrhythmias Cardiovasc Res, August 15, 2005; 67(3): 426 - 437. [Abstract] [Full Text] [PDF]
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M. Duytschaever, Y. Blaauw, and M. Allessie Consequences of atrial electrical remodeling for the anti-arrhythmic action of class IC and class III drugs Cardiovasc Res, July 1, 2005; 67(1): 69 - 76. [Abstract] [Full Text] [PDF]
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D. P. Zipes, M. J. Ackerman, N.A. M. Estes III, A. O. Grant, R. J. Myerburg, and G. Van Hare Task Force 7: Arrhythmias J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1354 - 1363. [Full Text] [PDF]
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A. Verma, O. M. Wazni, N. F. Marrouche, D. O. Martin, F. Kilicaslan, S. Minor, R. A. Schweikert, W. Saliba, J. Cummings, J. D. Burkhardt, et al. Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: An independent predictor of procedural failure J. Am. Coll. Cardiol., January 18, 2005; 45(2): 285 - 292. [Abstract] [Full Text] [PDF]
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E. G. Manios, E. M. Kallergis, E. M. Kanoupakis, H. E. Mavrakis, H. K. Mouloudi, N. K. Klapsinos, and P. E. Vardas Effects of successful cardioversion of persistent atrial fibrillation on right ventricular refractoriness and repolarization Europace, January 1, 2005; 7(1): 34 - 39. [Abstract] [Full Text] [PDF]
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J P Bourke, A Dunuwille, D O'Donnell, S Jamieson, and S S Furniss Pulmonary vein ablation for idiopathic atrial fibrillation: six month outcome of first procedure in 100 consecutive patients Heart, January 1, 2005; 91(1): 51 - 57. [Abstract] [Full Text] [PDF]
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A V Mattioli, S Bonatti, D Monopoli, M Zennaro, and G Mattioli Left atrial remodelling after short duration atrial fibrillation in hypertrophic hearts Heart, January 1, 2005; 91(1): 91 - 92. [Full Text] [PDF]
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P. Kohl Cardiac cellular heterogeneity and remodelling Cardiovasc Res, November 1, 2004; 64(2): 195 - 197. [Full Text] [PDF]
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L. Hove-Madsen, A. Llach, A. Bayes-Genis, S. Roura, E. R. Font, A. Aris, and J. Cinca Atrial Fibrillation Is Associated With Increased Spontaneous Calcium Release From the Sarcoplasmic Reticulum in Human Atrial Myocytes Circulation, September 14, 2004; 110(11): 1358 - 1363. [Abstract] [Full Text] [PDF]
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P. Sanders, P. M. Kistler, J. B. Morton, S. J. Spence, and J. M. Kalman Remodeling of Sinus Node Function in Patients With Congestive Heart Failure: Reduction in Sinus Node Reserve Circulation, August 24, 2004; 110(8): 897 - 903. [Abstract] [Full Text] [PDF]
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A. Goette and U. Lendeckel Tachycardia-induced remodeling: atria and ventricles take a different route Cardiovasc Res, August 1, 2004; 63(2): 194 - 195. [Full Text] [PDF]
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P. M. Kistler, P. Sanders, S. P. Fynn, I. H. Stevenson, S. J. Spence, J. K. Vohra, P. B. Sparks, and J. M. Kalman Electrophysiologic and electroanatomic changes in the human atrium associated with age J. Am. Coll. Cardiol., July 7, 2004; 44(1): 109 - 116. [Abstract] [Full Text] [PDF]
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D. G. Wyse and B. J. Gersh Atrial Fibrillation: A Perspective: Thinking Inside and Outside the Box Circulation, June 29, 2004; 109(25): 3089 - 3095. [Full Text] [PDF]
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A. Boldt, J. Garbade, J. F. Gummert, and S. Dhein Reply J. Am. Coll. Cardiol., June 16, 2004; 43(12): 2363 - 2364. [Full Text] [PDF]
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S. Nattel Defining "Culprit Mechanisms" in Arrhythmogenic Cardiac Remodeling Circ. Res., June 11, 2004; 94(11): 1403 - 1405. [Full Text] [PDF]
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G. K. Feld Catheter ablation of atrial fibrillation: what is the best technique for achieving a high cure rate with acceptable risk? J. Am. Coll. Cardiol., June 2, 2004; 43(11): 2054 - 2056. [Full Text] [PDF]
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B. J.J.M Brundel, H. H Kampinga, and R. H Henning Calpain inhibition prevents pacing-induced cellular remodeling in a HL-1 myocyte model for atrial fibrillation Cardiovasc Res, June 1, 2004; 62(3): 521 - 528. [Abstract] [Full Text] [PDF]
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