Electrophysiological remodeling in dilated cardiomyopathy and heart failure

Cardiac remodeling commonly refers to a persistent change in the properties of the myocardium in response to external stress. Cardiac remodeling occurs prominently in the setting of structural heart disease such as myocardial infarction, hypertrophy, and heart failure (HF), but may also occur in the absence of mechanical dysfunction, as is the case during abrupt changes in heart rate and/or activation sequence. As such, remodeling is a prominent feature of atrial fibrillation, flutter, complete heart block, ventricular pacing, and tachycardia. Remodeling is induced by changes in gene expression, which, in turn, alter the expression of key regulatory proteins, the distribution and function of subcellular organelles, the size and morphology of individual cells, the properties of the extracellular matrix, and ultimately those of the entire organ.