Atrial Remodeling in Permanent Atrial Fibrillation: Mechanisms and Pharmacological Implications

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. Atrial Remodeling in Permanent Atrial Fibrillation: Mechanisms and Pharmacological Implications Danina M Muntean1, Zsófia Kohajda2,3, Tamás Fazekas4 and Norbert Jost1-3* 1Department of Pathophysiology, University of Medicine and Pharmacy, Timisoara, Romania 2Division of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary 3Department of Pharmacology & Pharmacotherapy, Faculty of Medicine, University of Szeged, Hungary 4First Department of Internal Medicine, Faculty of Medicine, University of Szeged, Hungary