Stretch Induced Pulmonary Vein Remodelling: Implications for the Initiation and Maintenance of Atrial Fibrillation

房颤(房颤)是影响人类的最常见的心律失常，在2%的成年人中发生。这是一种心脏顶室的混乱节律紊乱，导致频繁因跌倒、胸痛、心悸、心力衰竭和中风而住院。此外，它还与死亡率的增加有关。有证据表明，肺静脉在房颤的发生和维持中起着重要作用。然而，为什么这些结构促进房颤仍不清楚。几种易发生房颤的情况与心房伸展有关(如心力衰竭)。这些情况记录了心房内的异常，但发生在静脉曲张内的变化尚不清楚。甚至有人提出，在有适当倾向的患者中，血流引起的搏动性伸展可能足以触发房颤。因此，已经进行了密集的搜索，以确定发生在静脉曲张内的异常。在房颤患者中，与无房颤患者相比，静脉曲张表现出独特的电生理特性。然而，作为一种常见的诱发因素，拉伸对PV电生理特性的影响尚不清楚。通过消融来阻止室上性心动过速与心脏的电活动，让我们得以一窥我们治愈房颤的能力。然而，我们程序性技术的进一步改进，预防这种节律紊乱的发生的能力，以及非侵入性治疗房颤的策略的发展，取决于对引发和维持这种情况的机制的更好理解。特别是，静脉曲张内的电生理变化使患者易于发生房颤，需要进行研究。这一系列研究将评估急性和慢性拉伸对人类静脉曲张的影响，以确定为什么这些结构促进房颤。

Atrial fibrillation (AF) is the most common heart rhythm disorder to affect humans, occurring in 2% of adults. It is a chaotic rhythm disorder of the top chambers of the heart that results in frequent hospitalization for falls, chest pain, palpitations, heart failure and stroke. In addition, it is associated with an increased mortality. Evidence suggests an important role of the pulmonary veins (PV; veins draining blood from the lungs back to the heart) in the initiation and maintenance of AF. However, why these structures promote AF remains unknown. Several conditions predisposing to the development of AF are associated with atrial stretch (such as heart failure). These conditions have documented abnormalities within the atria but the changes that occur within the PVs are unknown. It has even been suggested that pulsatile stretch, as caused by blood flow, in the appropriately predisposed patient, may be enough to trigger AF. As such there has been an intensive search to identify the abnormalities that occur within the PVs. In patients with AF, the PVs demonstrate distinctive electrophysiological properties compared to those without AF. However, the effect of stretch, a common predisposing factor, on the electrophysiological properties of the PV is not known. Preventing electrical activity from the PVs interacting with the heart by ablation has provided a glimpse at our ability to cure AF. However, further improvements in our procedural technique, the ability to prevent the occurrence of this rhythm disorder, and the development of noninvasive strategies to cure AF, hinges on the better understanding of the mechanisms initiating and maintaining this condition. In particular, the electrophysiological changes within the PVs that predispose patients to the development of AF need to be investigated. This series of studies will evaluate the effect of acute and chronic stretch on the PVs in humans to determine why these structures promote AF.