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Atrial electrophysiologic remodeling: another vicious circle?
1Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.
Insights
Acquired heart disease, including atrial fibrillation (AF), often results from gradual changes. Research now explores long-term adaptations like electrical remodeling, crucial for understanding arrhythmia progression.
Area of Science:
- Cardiology
- Electrophysiology
- Pathophysiology
Background:
- Acquired heart disease, including atrial fibrillation (AF), typically develops gradually over months or years.
- Most current knowledge on cardiac arrhythmias stems from acute experiments, overlooking slow pathological processes.
- Recent research highlights long-term adaptation mechanisms such as cardiac memory and electrical remodeling.
Discussion:
- Atrial fibrillation (AF) can create a self-perpetuating cycle of electrophysiologic and structural changes in the heart.
- This phenomenon, termed "AF begets AF," leads to the "domestication" of the arrhythmia.
- This article reviews studies investigating AF-induced electrophysiologic and cellular remodeling.
Key Insights:
- Focusing on long-term adaptations is essential for understanding chronic cardiac conditions.
- Experimental models demonstrate that AF can induce progressive changes, solidifying the arrhythmia.
- Understanding cellular and electrical remodeling is key to addressing AF progression.
Outlook:
- Further research into long-term adaptation processes is needed.
- Investigating AF-induced remodeling may reveal new therapeutic targets.
- Translating findings from experimental models to clinical practice is a future goal.
Introduction:
With few exceptions, acquired heart disease is the result of gradual changes in the heart, progressing during several months or years. This also includes certain cardiac arrhythmias, as for instance atrial fibrillation (AF). In spite of the important role of slowly progressing pathologic processes, most of our knowledge about mechanisms of cardiac arrhythmias is based on acute experiments. Only recently, the attention also is more focused on long-term adaptation processes like cardiac memory, electrical remodeling, and tachycardia-induced cardiomyopathy. In experimental animal models, it has been shown that AF induces a vicious circle of electrophysiologic and structural changes that inevitably leads to "domestication" of the arrhythmia ("AF begets AF"). In this article, the studies on AF-induced electrophysiologic and cellular remodeling are discussed.