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High-Frequency Atrial Excitation Leads to Persistent AF by Inducing Electrical and Structural Remodeling
(Left) Increased aldosterone during high-frequency stimulation contributes to structural remodeling via atrial cardiomyocyte hypertrophy, atrial dilation, myofibroblast proliferation, increased collagen synthesis, and extracellular matrix remodeling. (Right) By blocking aldosterone, eplerenone minimizes structural but not electrical remodeling. AF = atrial fibrillation; Aldo = aldosterone; ECM = extracellular matrix; EPL = eplerenone; MR = mineralocorticoid receptor.