Mechanism of Atrial Remodeling in Atrial Fibrillation and the Upstream Targets of Yang-warming and Blood-activating Therapy for Inhibiting Atrial Remodeling
Atrial fibrillation(AF) is a common arrhythmia and is associated with significant morbidity and mortality.Atrial remodeling is important for the occurrence,progression,and persistence of AF,mainly including electrical and structural remodeling.Structural remodeling is often more difficult to be reversed than electrical remodeling.Therefore,effective inhibition of atrial remodeling is very important to prevent the development and persistence of AF.The main upstream targets of AF include L-type calcium channel(LTCC),atrial connexin,renin-angiotensin-aldosterone system(RAAS),matrix metalloproteinases(MMPs),oxidative stress and inflammatory responses.The modern therapies comprise drug therapy and non-drug therapy,which,however,have some side effects and adverse reactions.Traditional Chinese medicine,with holistic concept and syndrome differentiation-based treatment,has remarkable advantages in improving clinical efficacy,cardiac electrophysiology and structural function.As a major syndrome of AF,yang deficiency and blood stasis can enhance atrial remodeling.For AF with the syndrome of yang deficiency and blood stasis,the yang-warming and blood-activating therapy can not only reduce the occurrence frequency and duration of AF but also inhibit the upstream link of atrial remodeling,thus reversing remodeling,preventing recurrence,and improving prognosis.