Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation.
Left atrial (LA) structural and functional remodeling reflects a spectrum of pathophysiological changes that have occurred in response to specific stressors. These changes include alterations at the levels of ionic channels, cellular energy balance, neurohormonal expression, inflammatory response, and physiologic adaptations. There is convincing evidence demonstrating an important pathophysiological association between LA remodeling and atrial fibrillation (AF). Measures that will prevent, attenuate, or halt these processes of LA remodeling may have a major public health impact with respect to the epidemic of AF. In this review, we describe the mechanisms involved in LA remodeling and highlight the existing and potential therapeutic options for its reversal, and implications for AF development.
Casaclang-Verzosa
Grace
G
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55901, USA.
Gersh
Bernard J
BJ
Tsang
Teresa S M
TS
D000375:Aging; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy; D017115:Catheter Ablation; D002986:Clinical Trials as Topic; D004554:Electric Countershock; D022062:Electrophysiologic Techniques, Cardiac; D006325:Heart Atria / Q000187:drug effects / Q000378:metabolism* / Q000503:physiopathology*; D006801:Humans
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000933:Antifibrinolytic Agents