By Masayasu Hiraoka, International Congress on Electrocardiol
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Additional resources for Advances in Electrocardiology 2004: Proceedings of the 31th International Congress on Electrocardiology (Advances in Electrocardiography)
This has been investigated by Allessie and co-workers who showed that an Ikur blocker AVEO118 can cardiovert persistent atrial fibrillation by prolonging especially the very short action potentials of the remodeled atria. It may be concluded that Ikur block is more effective in prolonging effective refractory period in remodeled compared to normal atria. In addition, inhibiting both Ikur and Ikr may produce supra-additive effects on the action potential duration. These conclusions have appeared from the work of Courtemanche and Nattel and show that mathematical models may provide insight in new ionic targets for drug therapy in AF induced electrical remodeling.
Recent optical mapping studies showed that atrial premature beats induce functional reentry preferentially in the PVs . There are abrupt changes in myocardial fiber orientations near the vein ostium, resulting in marked conduction delays during premature or rapid excitations due to source-sink 29 mismatch. Such complex no-uniform anisotropic architecture of the PV myocardial sleeves combined with distinct cellular electrophysiological properties (abbreviated refractoriness and reduced ability to provide source current for conduction, as described above) may favor the formation of functional reentry .
Structural Remodeling mostly Occurs while Patient is in Sinus Rhythm Although this is one mechanism, atrial structural remodeling which usually occurs during sinus rhythm, is probably more important. Stretch of the atria in the setting of hypertension or valvular disease is the main trigger for fibrosis. In some sub sets of patients amyloidosis may occur especially in elderly women with valvular heart disease. Clinical Consequences of Atrial Remodeling Among the clinical consequence of atrial remodeling are (1) progression to permanent AF due to changes in ion channels, connexin down regulation, myolysis and fibrosis.
Advances in Electrocardiology 2004: Proceedings of the 31th International Congress on Electrocardiology (Advances in Electrocardiography) by Masayasu Hiraoka, International Congress on Electrocardiol