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J Am Coll Cardiol, 2008; 51:1-11, doi:10.1016/j.jacc.2007.09.026
© 2008 by the American College of Cardiology Foundation
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STATE-OF-THE-ART PAPER

Structural and Functional Remodeling of the Left Atrium

Clinical and Therapeutic Implications for Atrial Fibrillation

Grace Casaclang-Verzosa, MD, FPCC, Bernard J. Gersh, MB, ChB, DPhil, FACC and Teresa S.M. Tsang, MD, FACC*

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.

Manuscript received August 30, 2007; accepted September 26, 2007.

* Reprint requests and correspondence: Dr. Teresa S. M. Tsang, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55901. (Email: tsang.teresa{at}mayo.edu).

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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