Pulmonary vein remodeling in hypertension: Mechanistic insight into primary prevention of atrial fibrillation

Epidemiological studies have shown that several risk factors, such as increasing age, hypertension, heart failure, myocardial infarction, and valvular heart disease, are known to be independent predictors of the development of atrial fibrillation (AF) (1). Among them, the relative risks due to hypertension are lower, compared with heart failure and valvular disease; however, the population at risk of AF as a result of hypertension is high because it is epidemiologically the most prevalent, especially among the elderly. Therefore, it is important to prevent the development of AF in patients with hypertension. Electrical and structural remodeling in both the atria and the pulmonary veins (PVs) has been observed at the time AF occurred in patients with hypertension (2). Unfortunately, the therapeutic options for structural remodeling (i.e., reverse remodeling) of the atria are currently limited.