Atrial remodeling for atrial fibrillation

By Gaea Miranda, BA

Atrial fibrillation (AF) is a term referring to the irregular heartbeat or arrhythmia that may result in blood clots, heart failure, stroke, and other cardiac complications. With millions of AF, the disease accounts for about 2% of the death rates from heart disease.

The researchers sought to study the mechanisms and factors involved in the development of the disease in order to provide relevant and effective measures of treatment.

Atrial remodeling has been found to be an effective method for alleviating such a phenomenon. Studies have shown that remodeling or restructuring the heartbeat through various mechanisms limits the progression of the disease. As such, many doctors and medical practitioners resort to atrial remodeling when they are confronted with a diagnosis of atrial fibrillation.

Apparition and development of atrial fibrillation

It is thought that atrial fibrillation is a progressive heart disorder disorder that ultimately induces electrical, microanatomical, neurohormonal, contractile and ultrastructural changes in the cardiac system.

From a paroxysmal dysfunction, atrial fibrillation (through various genetic, physiological and environmental influences) evolves to a persistent and permanent dysfunction. Studies in cardiology have linked the risk of cardiovascular disorders with atrial fibrillation, the latter developing more in patients with higher cardiovascular risks or predispositions. 9004] Being the most common form of arrhythmia, atrial fibrillation can occur at any age, but it is extremely common in the elderly, probably because of its progressive nature. Studies have shown that AF is triggered when an atrial ectopic beat meets anatomical or functional barriers that trigger wavefront excitation.

This specific excitation is characterized by triggered depolarization activities or increased automaticity. At the same time, the persistence and progression of AF is explained either by the presence of reentry circuits or by the activities of cardiac electrical rotors.

The use of atrial remodeling

The last ten years have seen the development of atrial remodeling as a tool to relieve the progression of atrial fibrillation. Any anomaly of the auricular function constitutes a need for atrial remodeling; as such, many types of modeling techniques are currently available to solve start-stop problems.

Electrical remodeling

The use of electrical remodeling is performed when multiple ion channels, badociated with a shortening of the potential for action (AP), are altered. Electrical remodeling targets in particular the electrophysiological atrial parameters resulting from prolonged changes in the atrial rhythm.

By targeting atrial refraction and slowing the conduction velocity of the atrial substrate, electrical remodeling is able to reduce the progression of AF. Although inversion of electrical remodeling usually occurs one week after the restoration of atrial fibrillation to sinus rhythm, the method may still be a repetitive and long-term effort.

Contractile Remodeling

A consequence of impaired calcium manipulation remodeling is characterized by the loss of atrial contractility and atrial dilation. Although this method seems promising, studies have argued that atrial dilation can facilitate atrial thrombosis during the treatment period, which is why this remodeling technique is not recommended. More recent studies have challenged this theory, but more experiments and data should be conducted to test its accuracy and reliability.

Structural Remodeling

S addressing primarily to the primary activators of atrial fibrillation, structural remodeling targets chronic atrial extension and geometric deformities present in the cardiac structure. More specifically, this method targets both cellular and non-cellular components of atrial tissues that facilitate other changes in atrial function. Since this technique uses the same components that facilitate the progression of atrial fibrillation in the first place, structural remodeling is considered a less reversible technique that can lead to heart failure and other cardiac conditions.

Although various atrial remodeling techniques are currently available, the need for more appropriate AF solutions remains an important focus of contemporary medical research. Medical engineers, practitioners and researchers are currently trying to develop technological cardiac innovations for use in a more accurate and efficient AF treatment process

Reviewed by: Dr. Tomislav Meštrović , MD, PhD

Further reading