Atrial Remodelling : Role in Atrial Fibrillation Ablation

There have been considerable advances in understanding the relationship of atrial fibrillation (AF) and atrial remodelling suggesting that remodelling states have a significant impact on treatment results. Therefore, we reviewed the literature about the role of atrial remodelling in AF treatment, focussing on AF ablation. Atrial fibrillatory activity, dominant frequencies (DF), complex fractionated atrial electrograms (CFAE) as well as function, volume, and fibrosis of the - especially left - atrium are most important characteristics for electrical, contractile, and structural remodelling predicting success of AF treatment. In particular, the results of AF ablation, either using catheter-based or surgical techniques, predominantly depend on the degree of structural remodelling, namely dilatation and fibrosis of the left atrium. The available data suggest that recognizing parameters of remodelling as predictors for AF treatment facilitates differentiation between patients who may or may not benefit from the procedure and individualization of AF treatment by adapting lesion sets, by ablating additional targets, by reducing left atrial size, or by applying extended pharmacological treatment.