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Atrial remodeling and atrial fibrillation recurrence after catheter ablation

Past, present, and future developments

Atriales Remodeling und Rezidiv des Vorhofflimmerns nach Katheterablation

Entwicklungen der Vergangenheit, Gegenwart und Zukunft

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Abstract

The term “atrial remodeling” is used to describe the electrical, mechanical, and structural changes associated with the presence of an arrhythmogenic substrate for atrial fibrillation. Rhythm control therapy may slow down or even reverse progressive atrial remodeling. Atrial remodeling has long been recognized as an important predictor of clinical outcomes and therapeutic success, but recent advances have highlighted its clinical relevance and revealed the implications of specific anatomical changes such as atrial asymmetry or shape. This has opened the path to computational precision medicine that captures these data in detail and combines them with other factors, to provide patient-specific solutions. The goal of precision medicine lies in improving clinical outcomes, reducing costs, and avoiding unnecessary procedures. In this article, we review the history of atrial remodeling and we summarize the insights from our research on anatomical atrial remodeling and its association with rhythm outcomes after catheter ablation. Finally, we present recent advances in the field, reflecting the beginning of a new technological era that will enable us to improve patient care by personalized patient-specific medicine.

Zusammenfassung

Der Begriff „atriales Remodeling“ wird verwendet, um die elektrischen, mechanischen und strukturellen Veränderungen der Vorhöfe zu beschreiben, die mit dem Vorhandensein eines arrhythmogenen Substrats für Vorhofflimmern verbunden sind und die sich durch Rhythmuskontrolle z. T. rückbilden lassen. Das atriale Remodeling ist seit Langem als wichtiger Prädiktor für klinische Ergebnisse und rhythmuserhaltenden Erfolg anerkannt, wurde aber in letzter Zeit weiter und intensiver im Hinblick auf spezifische anatomische Veränderungen der Form oder Asymmetrie untersucht. Diese Studien haben die klinische Relevanz und die Bedeutung solcher Veränderungen aufgezeigt. Dies hat den Weg zur rechnergestützten Präzisionsmedizin geebnet, die diese Daten detailliert erfasst und mit anderen Faktoren kombiniert, um patientenspezifische Lösungen bereitzustellen. Das Ziel der Präzisionsmedizin besteht zum einen darin, klinische Ergebnisse zu verbessern, zum anderen auch darin, Kosten zu senken und unnötige Prozeduren zu vermeiden. Im vorliegenden Artikel geben die Autoren einen Überblick über die Vorgeschichte des atrialen Remodelings und fassen die Erkenntnisse aus ihrer Forschung zum anatomischen atrialen Remodeling und dessen Zusammenhang mit den Rhythmusergebnissen nach Katheterablation zusammen. Schließlich werden die jüngsten Fortschritte auf diesem Gebiet zu Beginn eines neuen technologischen Zeitalters präsentiert, das es ermöglichen wird, die Patientenversorgung durch personalisierte patientenspezifische Medizin zu verbessern.

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Authors and Affiliations

  1. Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany

    Sotirios Nedios MD, PhD, Frank Lindemann, Andreas Bollmann & Gerhard Hindricks

  2. Department of Cardiology, CardiovascularResearch Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands

    Jordi Heijman & Harry J. G. M. Crijns

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  1. Sotirios Nedios MD, PhD
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  2. Frank Lindemann
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Correspondence to Sotirios Nedios MD, PhD.

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Conflict of interest

S. Nedios, F. Lindemann, J. Heijman, H. J. G. M. Crijns, A. Bollmann, and G. Hindricks declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Sotirios Nedios and Frank Lindemann contributed equally to the manuscript.

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Nedios, S., Lindemann, F., Heijman, J. et al. Atrial remodeling and atrial fibrillation recurrence after catheter ablation. Herz 46, 312–317 (2021). https://doi.org/10.1007/s00059-021-05050-1

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