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Déterminants du remodelage atrial et de son effet pro-arythmique dans la fibrillation atriale

Abstract : Rational : Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Atrial remodeling, whether electrical or structural, leads to the development of atrial cardiomyopathy. The aim of the thesis was to characterize the determinants of atrial remodeling, and their proarrhythmic effect in AF.Main results :The first part of the thesis focused on the characterization of the atrial remodeling induced by sustained atrial flutter (AFL) in a chronic canine model AFL caused electrical remodeling but no structural. In addition, AFL ablation significantly reduced arrhythmia duration but not AF vulnerability.The second part of the thesis characterized the differential role of atrial arrhythmia and ventricular response in AF-induced atrial remodeling. Lone atrial arrhythmia and lone high-rate ventricular response induced atrial remodeling. In addition, there was a synergistic effect on atrial remodeling of combined atrial arrhythmia and high ventricular rate, especially regarding fibrosis.The third part of the thesis studies the ability of cilnidipine, an N- and L-type calcium channel blocker, to alter autonomic, electrical and structural remodeling associated with chronic AF, in a subacute and chronic dog model. Cilnidipine’s electrical and structural anti-remodeling properties were associated with suppression of the changes in autonomic tone caused by AF.Conclusion - This work provides new insights into the mechanisms involved in AF-related atrial remodeling and introduces novel preventive approaches.
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Jean-Baptiste Guichard. Déterminants du remodelage atrial et de son effet pro-arythmique dans la fibrillation atriale. Médecine humaine et pathologie. Université de Lyon; Université de Montréal. Faculté de médecine, 2019. Français. ⟨NNT : 2019LYSES025⟩. ⟨tel-02505569⟩

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