Abstract
Atrial fibrillation (AF) is characterized by disorganized rapid atrial electrical activity, which leads to impaired atrial function, adverse hemodynamic effects, and increased thromboembolic risk. The paroxysmal forms of AF can be effectively treated with current pharmacological and non-pharmacological modalities by targeting the arrhythmia triggers. Persistent AF, however, is more difficult to treat due to remodeling processes which may become major factors in the maintenance of the arrhythmia, rendering trigger-targeting treatment options less effective. We will systematically review the recent findings of the development and maintenance of persistent AF, including genetic, cellular, organ level, and systemic processes. As AF remains the most common sustained arrhythmia with the ongoing need to find effective treatment, we will also discuss potential treatment options targeting the remodeling processes.