The role of atrial electrical remodeling in the progression of focal atrial ectopy to persistent atrial fibrillation

Focal Atrial Fibrillation and Electrical Remodeling. Although atrial fibril lation- (AF) induced changes in atrial refractoriness (atrial electrical re modeling) have been demonstrated in a number of different animal models, th e clinical significance of this process is unknown. We describe a patient i n whom there has been documented progression of atrial ectopy to persistent AF accompanied by evidence of atrial electrical remodeling, with reversal of remodeling following successful ablation of the focal source of AF. A se cond patient with focal AF, but with a "nonfocal" appearance on the ECG, is also described. These cases illustrate: (1) the possibility that a signifi cant proportion of younger patients with idiopathic persistent AF may well ha re a focal source as the underlying abnormality; and (2) atrial electric al remodeling reverses following ablation of the underlying source.