Catheter Ablation by Kenzo Hirao

Author:Kenzo Hirao
Language: eng
Format: epub
Publisher: Springer Singapore, Singapore

21.4 Reverse Remodeling of Fibrosis

If AF is associated with fibrosis, then, can fibrotic tissue be reversed after AF is restored to sinus rhythm? There are some papers that examined this issue. In a canine AF model created by mitral regurgitation and rapid atrial pacing for more than 8 weeks, AF was still easily induced by atrial pacing 7–14 days after restoration of sinus rhythm where structural changes remained unchanged, consisting of swollen myocytes, an increase in the extracellular matrix, an increased number or size of mitochondria, and destruction of the sarcoplasmic reticulum, but the number of ectopy and an abbreviation of the effective refractory period both recovered to the control level. In a goat model, burst atrial pacing was performed in order to sustain AF for 4 months, and what was occurring after sinus rhythm restoration was observed [27]. Of note, the extracellular matrix continued to increase even if 4 months had passed after restoration of sinus rhythm. Those findings suggested that the process of reverse remodeling of fibrosis is slow.

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