There have been considerable advances in understanding
the relationship of atrial fibrillation (AF) and atrial remodelling suggesting
that remodelling states have a significant impact on treatment results.
Therefore, we reviewed the literature about the role of
atrial remodelling in AF treatment, focussing on AF ablation.
Atrial fibrillatory activity, dominant frequencies (DF), complex
fractionated atrial electrograms (CFAE) as well as function, volume, and
fibrosis of the – especially left – atrium are most important characteristics
contractile, and structural remodelling predicting success of AF treatment. In
particular, the results of AF ablation, either using catheter-based or
surgical techniques, predominantly depend on the degree of structural
remodelling, namely dilatation and fibrosis of the left atrium.
available data suggest that recognizing
parameters of remodelling as predictors for AF treatment facilitates (1)
differentiation between patients who may or may not benefit from the procedure
and (2) individualization of AF treatment by adapting lesion sets, by ablating
additional targets, by reducing left atrial size, or by applying extended upstream
Credits: Herko Grubitzsch, MD, PhD; Wilhelm Haverkamp, MD, PhD