Atrial remodelling

Over time, untreated atrial fibrillation (AF) leads to structural remodelling of the atria that can break the electrical connection between muscle bundles. This produces local changes in conduction that favour re-entry circuits and maintain AF. Some structural remodelling is irreversible, underscoring the importance of early detection and treatment.5

For instance, increased left atrial pressure and size can disorganise connective tissue and cause interstitial fibrosis. These changes can slow atrial conduction, increase local electrical abnormalities and result in conduction block. Furthermore, congestive heart failure (CHF) and AF can activate the renin-angiotensin-aldosterone system (RAAS), which contributes to inflammation and fibrosis. This also results in remodelling. Age-related fibrosis could also contribute to AF onset and maintenance.6 Structural remodelling can develop rapidly. In experimental models, structural remodelling can occur after a week of sustained rapid pacing, for example.21

Read about abnormal calcium flux in the next section

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