Mechanisms of atrial remodeling in patients with atrial fibrillation and their relationship with the effectiveness of various treatment methods

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Abstract

Atrial fibrillation (AF) is the most common type of tachyarrhythmia among patients with a cardiology profile. AF causes significant changes in the atrial myocardium – remodeling. The concept of atrial remodeling includes changes at several main levels: electrical remodeling, mechanical remodeling, structural remodeling, as well as endocrine and vegetative changes. Modern interventional methods of treating AF demonstrate high efficiency, provide «freedom from arrhythmia» in the long term and improve tolerance of relapses. Long-term persistence of AF reduces the chances of success of catheter treatment methods due to electrical, mechanical and structural remodeling of the atria. Perhaps, upon achieving reverse remodeling of the atria after restoration and maintenance of the rhythm, these chances will increase significantly. This issue currently remains open and requires additional research.

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About the authors

A. V. Tarasov

National Medical Research Center for Therapy and Preventive Medicine, Department of Surgical Treatment of Complex Heart Rhythm Disorders and Electrical Pacing

Author for correspondence.
Email: a730tv@yandex.ru
ORCID iD: 0000-0003-4277-1711

Dr. Sci. (Med.), Head of the Department of Surgical Treatment of Complex Heart Rhythm Disorders and Electrical Pacing, Head of the Clinic of Therapeutic Arrhythmology

Russian Federation, Moscow

A. A. Karakiyan

Ryazan Regional Cardiology Dispensary of the Ministry of Health of the Ryazan Region, Department of Surgical Treatment of Complex Heart Rhythm Disorders and Electrical Pacing

Email: a730tv@yandex.ru
ORCID iD: 0009-0008-5275-9437
Russian Federation, Ryazan

V. O. Povarov

Ryazan Regional Cardiology Dispensary of the Ministry of Health of the Ryazan Region, Department of Surgical Treatment of Complex Heart Rhythm Disorders and Electrical Pacing

Email: a730tv@yandex.ru
ORCID iD: 0000-0001-8810-9518
Russian Federation, Ryazan

References

  1. Krijthe B.P., Kunst A., Benjamin E.J., et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34(35):2746–51. doi: 10.1093/eurheartj/eht280.
  2. Kopecky S.L., Gersh B.J., McGoon M.D., et al. The natural history of lone atrial fibrillation. A population-based study over three decades. N Engl J Med. 1987;317(11):669–74. doi: 10.1056/NEJM198709103171104.
  3. Jahangir A., Lee V., Friedman P.A., et al. Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study. Circulation. 2007;115(24):3050–6. doi: 10.1161/CIRCULATIONAHA.106.644484.
  4. Kato T., Yamashita T., Sagara K., et al. Progressive nature of paroxysmal atrial fibrillation. Observations from a 14-year follow-up study. Circ J. 2004;68(6):568–72. doi: 10.1253/circj.68.568.
  5. Wijesurendra R.S., Casadei B. Mechanisms of atrial fibrillation. Heart. 2019;105(24):1860–7. doi: 10.1136/heartjnl-2018-314267.
  6. Pina P.G., Chicos A.B. Early Cardioversion in Atrial Fibrillation: Earlier Is Better, but Not Always and (Maybe) Not Immediately. Curr Atheroscler Rep. 2017;19(1):3. doi: 10.1007/s11883-017-0638-1.
  7. Margulescu A.D., Mont L. Persistent atrial fibrillation vs paroxysmal atrial fibrillation: differences in management. Expert Rev Cardiovasc Ther. 2017;15(8):601–18. doi: 10.1080/14779072.2017.1355237.
  8. Nyong J., Amit G., Adler A.J., et al. Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation. Cochrane Database Syst Rev. 2016;11(11):CD012088. doi: 10.1002/14651858.CD012088.pub2.
  9. Wijffels M.C., Kirchhof C.J., Dorland R., Allessie M.A. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation. 1995;92(7):1954–68. doi: 10.1161/01.cir.92.7.1954.
  10. Daoud E.G., Bogun F., Goyal R., et al. Effect of atrial fibrillation on atrial refractoriness in humans. Circulation. 1996;94(7):1600–6. doi: 10.1161/01.cir.94.7.1600.
  11. Sanchez J., Gomez J.F., Martinez-Mateu L., et al. Heterogeneous Effects of Fibroblast-Myocyte Coupling in Different Regions of the Human Atria Under Conditions of Atrial Fibrillation. Front Physiol. 2019;10:847. doi: 10.3389/fphys.2019.00847.
  12. Franz M.R., Karasik P.L., Li C., et al. Electrical remodeling of the human atrium: similar effects in patients with chronic atrial fibrillation and atrial flutter. J Am Coll Cardiol. 1997;30(7):1785–92. doi: 10.1016/s0735-1097(97)00385-9.
  13. Schotten U., Neuberger H.R., Allessie M.A. The role of atrial dilatation in the domestication of atrial fibrillation. Prog Biophys Mol Biol. 2003;82(1–3):151–62. doi: 10.1016/s0079-6107(03)00012-9.
  14. Yue L., Feng J., Gaspo R., et al. Ionic remodeling underlying action potential changes in a canine model of atrial fibrillation. Circ Res. 1997;81(4):512–25. doi: 10.1161/01.res.81.4.512.
  15. Coetzee W.A., Opie L.H. Effects of components of ischemia and metabolic inhibition on delayed afterdepolarizations in guinea pig papillary muscle. Circ Res. 1987;61(2):157–65. doi: 10.1161/01.res.61.2.157.
  16. Katra R.P., Laurita K.R. Cellular mechanism of calcium-mediated triggered activity in the heart. Circ Res. 2005;96(5):535–42. doi: 10.1161/01.RES.0000159387.00749.3c.
  17. Casaclang-Verzosa G., Gersh B.J., Tsang T.S. Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J Am Coll Cardiol. 2008;51(1):1–11. doi: 10.1016/j.jacc.2007.09.026.
  18. Black I.W., Fatkin D., Sagar K.B., et al. Exclusion of atrial thrombus by transesophageal echocardiography does not preclude embolism after cardioversion of atrial fibrillation. A multicenter study. Circulation. 1994;89(6):2509–13. doi: 10.1161/01.cir.89.6.2509.
  19. Grimm R.A., Leung D.Y., Black I.W., et al. Left atrial appendage «stunning» after spontaneous conversion of atrial fibrillation demonstrated by transesophageal Doppler echocardiography. Am Heart J. 1995;130(1):174–6. doi: 10.1016/0002-8703(95)90253-8.
  20. Schotten U., Greiser M., Benke D., et al. Atrial fibrillation-induced atrial contractile dysfunction: a tachycardiomyopathy of a different sort. Cardiovasc Res. 2002;53(1):192–201. doi: 10.1016/s0008-6363(01)00453-9.
  21. Ausma J., Litjens N., Lenders M.H., et al. Time course of atrial fibrillation-induced cellular structural remodeling in atria of the goat. J Mol Cell Cardiol. 2001;33(12):2083–94. doi: 10.1006/jmcc.2001.1472.
  22. Ausma J., Wijffels M., Thone F., et al. Structural changes of atrial myocardium due to sustained atrial fibrillation in the goat. Circulation. 1997;96(9):3157–63. doi: 10.1161/01.cir.96.9.3157.
  23. Allessie M., Ausma J., Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 2002;54(2):230–46. doi: 10.1016/s0008-6363(02)00258-4.
  24. Стукалова О.В., Кирилова В.С., Апарина О.П., Майков Е.Б. Оценка структурных изменений миокарда левого предсердия по данным магнитно-резонансной томографии с контрастированием до и после баллонной криоаблации у пациентов с персистирующей фибрилляцией предсердий. Евразийский кардиологический журнал. 2023;(2):38–46. [Stukalova O.V., Kirilova V.S., Aparina O.P., Maykov E.B. Assessment of structural changes in the left atrium myocardium according to cardiac magnetic resonance with contrast before and after balloon cryoablation in patients with persistent atrial fibrillation. Euras Heart J. 2023;(2):38–46. (In Russ.)]. doi: 10.38109/2225-1685-2023-2-38-46.
  25. Frangogiannis N.G. Can Myocardial Fibrosis Be Reversed? J Am Coll Cardiol. 2019;73(18):2283–5. doi: 10.1016/j.jacc.2018.10.094.
  26. Thiedemann K.U., Ferrans V.J. Left atrial ultrastructure in mitral valvular disease. Am J Pathol. 1977;89(3):575–604.
  27. Katritsis G., Calkins H. Catheter Ablation of Atrial Fibrillation - Techniques and Technology. Arrhythm Electrophysiol Rev. 2012;1(1):29–33. doi: 10.15420/aer.2012.1.29.
  28. Аракелян М.Г., Бокерия Л.А., Васильева Е.Ю. и др. Фибрилляция и трепетание предсердий. Клинические рекомендации 2020. Российский кардиологический журнал. 2021;26(7):4594. [Arakelyan M.G., Bockeria L.A., Vasilieva E.Yu., et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021;26(7):4594. (In Russ.)]. doi: 10.15829/1560-4071-2021-4594.
  29. Hindricks G., Potpara T., Dagres N., et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):507. doi: 10.1093/eurheartj/ehaa798.
  30. Фомина И.Г., Тарзиманова А.И., Ветлужский А.В. и др. (2006). Пропафенон при восстановлении и сохранении синусового ритма у больных с персистирующей формой фибрилляции предсердиЙ: новые результаты исследования «ПРОМЕТЕЙ». Consilium Medicum. 2006;8(11):82–5. [Fomina I.G., Tarzimanova A.I., Vetluzhskiy A.V., et al. PROpafenon pri vosstanovlenii i sokhranenii sinusovogo ritMa u bol’nykh s pErsisTiruyushchEy formoy fibrillyatsii predserdiY: novye rezul’taty issledovaniya «PROMETEY». Consilium Medicum. 2006;8(11):82–5. (In Russ.)].
  31. Попова Е.П., Лысковцев В.В., Каверина Н.В. Электрофизиологические эффекты и антиаритмическое действие препаратов I класса этмозина и этацизина в условиях активации парасимпатической нервной системы. Вестник аритмологии. 2005;37:57–61. [Popova E.P., Lyskovtsev V.V., Kaverina N.V. Electrophysiological effects and antiarrhythmic activity of i-class antiarrhythmics, etmozin and ethacyzin, in conditions of activation of parasympathetic autonomic nervous system. Vestnik Aritmologii. 2005;37:57–61. (In Russ.)].
  32. Шляхто Е.В., Трешкур Т.В., Овечкина М.А., Пармон Е.В. Что такое вагусные желудочковые аритмии и как их лечить? Кардиология СНГ. 2006;4:1. [Shljahto E.V., Treshkur T.V., Ovechkina M.A., Parmon E.V. What are vagal ventricular arrhythmias and how are they treated? Сardiologiya SNG. 2006;4:1. (In Russ.)].
  33. Миллер О.Н., Старичков С.А., Поздняков Ю.М. и др. Эффективность и безопасность применения пропафенона (Пропанорма®) и амиодарона (Кордарона®) у больных с фибрилляцией предсердий на фоне артериальной гипертонии, ишемической болезни сердца и хронической сердечной недостаточности с сохраненной систолической функцией левого желудочка многоцентровое открытое рандомизированное проспективное сравнительное исследование «ПРОСТОР». Российский кардиологический журнал. 2010;(4):55–71. [Miller O.N., Starichkov S.A., Pozdnyakov Yu.M., et al. Effectiveness and safety of propafenone (Propanorm®) and amiodarone (Cordarone®) in patients with atrial fibrillation, arterial hypertension, coronary heart disease, and chronic heart failure with intact left ventricular systolic function. Russian Journal of Cardiology. 2010;(4):55–71. (In Russ.)].
  34. Haissaguerre M., Jais P., Shah D.C., et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66. doi: 10.1056/NEJM199809033391003.
  35. Chen S.A., Hsieh M.H., Tai C.T., et al. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation. 1999;100(18):1879–86. doi: 10.1161/01.cir.100.18.1879.
  36. Kaba R.A., Cannie D., Ahmed O. RAAFT-2: Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation. Glob Cardiol Sci Pract. 2014;2014(2):53–5. doi: 10.5339/gcsp.2014.26.
  37. Pappone C., Rosanio S., Augello G., et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol. 2003;42(2):185–97. doi: 10.1016/s0735-1097(03)00577-1.
  38. Poole J.E., Bahnson T.D., Monahan K.H., et al. CABANA Investigators and ECG Rhythm Core Lab. Recurrence of Atrial Fibrillation After Catheter Ablation or Antiarrhythmic Drug Therapy in the CABANA Trial. J Am Coll Cardiol. 2020;75(25):3105–18. doi: 10.1016/j.jacc.2020.04.065.
  39. Fukui A., Tanino T., Yamaguchi T., et al. Catheter ablation of atrial fibrillation reduces heart failure rehospitalization in patients with heart failure with preserved ejection fraction. J Cardiovasc Electrophysiol. 2020;31(3):682–8. doi: 10.1111/jce.14369.
  40. Arora S., Jaswaney R., Jani C., et al. Ablation for Atrial Fibrillation in Patients With Concurrent Heart Failure. Am J Cardiol. 2020;137:45–54. doi: 10.1016/j.amjcard.2020.09.035.
  41. Bergonti M., Ascione C., Marcon L., et al. Left ventricular functional recovery after atrial fibrillation catheter ablation in heart failure: a prediction model. Eur Heart J. 2023; 44(35):3327–35. Doi:.1093/eurheartj/ehad428.
  42. Crawford M., Steinberg B.A., Ranjan R., et al. Mortality benefit with AF ablation: Impact of normal sinus rhythm seen in CABANA and EAST AFnet. J Cardiovasc Electrophysiol. 2024;35(3):538–46. doi: 10.1111/jce.16160.
  43. Packer D.L., Mark D.B., Robb R.A., et al. CABANA Investigators. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019;321:1261–74.

Supplementary files

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2. Fig. 1. Changes in action potential and effective refractory period in patients

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3. Fig. 2. Three-dimensional models of the left atrium, reconstructed on the basis of magnetic resonance imaging with delayed contrast. The severity of fibrosis is ranked according to the Utah scale (grade 1 <10%; grade 2 a10-<20%, grade 3 a20-<30% and grade 4 ^30%)

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4. Fig. 3. Electroanatomical mapping of the LA in a patient with AF. Uneven activation of the atrial myocardium due to the presence of varying degrees of fibrosis

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