State-of-the-Art Paper
Structural and Functional Remodeling of the Left Atrium: Clinical and Therapeutic Implications for Atrial Fibrillation

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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.

Abbreviations and Acronyms

ACE
angiotensin-converting enzyme
AF
atrial fibrillation
ALT-711
alagebrium chloride
Ang-II
angiotensin II
ANP
atrial natriuretic peptide
BNP
brain natriuretic peptide
CRP
C-reactive protein
LA
left atrium/atrial
LV
left ventricle/ventricular
MMP
matrix metalloproteinase
TIMP
tissue inhibitor of metalloproteinase

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Dr. Casaclang-Verzosa is supported by the Mayo Clinic. Dr. James B. Seward’s Nasseff Professorial Grant. Dr. Tsang is supported by NIH RO1 AG22070 and an American Society of Echocardiography Echo Investigator Award.