Reverse Electrical Remodeling Induced by Sinus Rhythm and Calcium Channel Blockers May Play a Role for Better Long-Term Follow-Up Results in Patients With Long Standing Persistent Atrial Fibrillation and Treated With Cryo-Balloon Ablation

Abstract

The electrical disconnection of the pulmonary veins(PV) from the left atrium (LA) by cryo-balloon ablation (CB), hasproven effective to treat patients (pts) with atrialfibrillation (AF).However the results significantly differ from paroxysmal to persistent,and several factors related with the atrial remodeling process play animportant role on this. AF causes electrical remodeling, and chronicAF led to shortening of the atrial effective refractory period (AERP),and to loss of its physiological rate adaptation, which could make atriamore vulnerable tofibrillation. Human and experimental studies havedemonstrated that electrophysiological changes are influenced byintracellular calcium overload,and verapamil (VP), but not otherantiarrhythmic drugs (ADD) could markedly attenuate this effect.According with the aforementioned, we sought to achieve electricalatrial stabilization with VP after cardioversion (CV) 3 months beforeCB-PV ablation in patients with long standing persistent atrialfibril-lation (LSPAF).