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• W2153454865 abstract "Atrial fibrillation (AF) is endemic among the older population. Although there is no compelling argument for the contingency of sinus rhythm, based on hard outcomes, treating physicians commonly consider cardioversion for this most common arrhythmia. The decision to pursue a rhythm control strategy, over a rate control strategy for an individual patient can be a challenge. Usually, this decision is driven by the severity of ongoing symptoms despite rate control. In addition, other factors are considered, including the capacity and effort necessary to maintain sinus rhythm over the long-term. Traditionally, imaging the left atrium (LA) has been clinically useful as a marker of chronicity of disease. Whether imaging of the right atrium has anything to add has not been well investigated. When AF occurs, electrical and structural remodelling alter the atria, resulting in a substrate for further AF. It can be difficult to predict the extent to which atrial remodelling might be reversible in the clinical setting. Animal models of AF reproduce a wide array of changes in the atria. Rapid atrial pacing results in calcium overload-induced reduction in calcium currents, sodium currents, and altered potassium currentsdso called electrical remodelling. These changes reduce action potential duration and conduction velocity and perpetuate AF. In addition, myolysis, reduced atrial contractility, and atrial stretch occur but might be potentially reversible when atrial rates return to normal. Heart failure models of AF produce a significant degree of atrial fibrosis and left atrial enlargement, with much less effect on ion currents and action potential durationdso called structural remodelling. There is much less potential for reversibility of the structural changes in the atria even when pacing-induced heart failure is stopped. Electrical and structural remodelling have been demonstrated in human AF and it is likely that most patients have a mixed picture. The challenge for clinicians is" @default.
• W2153454865 created "2016-06-24" @default.
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• W2153454865 date "2015-01-01" @default.
• W2153454865 modified "2023-09-24" @default.
• W2153454865 title "When It Comes to Atrial Fibrillation Recurrence, Perhaps We Should Look Both Left and Right" @default.
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• W2153454865 doi "https://doi.org/10.1016/j.cjca.2014.11.019" @default.
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