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. Author manuscript; available in PMC: 2018 Dec 12.
Published in final edited form as: J Am Coll Cardiol. 2017 Dec 12;70(23):2893–2905. doi: 10.1016/j.jacc.2017.10.014

Central Illustration. High frequency atrial excitation leads to persistent AF by inducing electrical and structural remodeling.

Central Illustration

Left, increased aldosterone during high frequency stimulation contributes to structural remodeling via atrial cardiomyocyte hypertrophy, atrial dilatation, myofibroblast proliferation, increased collagen synthesis and extracellular matrix (ECM) remodeling. Right, by blocking aldosterone, eplerenone (EPL), minimizes structural but not electrical remodeling.