Atrial fibrosis is one of the fundamental mechanisms for the pathogenesis of atrial fibrillation (AF), but the underlying electrophysiological changes involved are not completely understood. Aging, neurohumoral activation, and chronic atrial stretch due to structural heart disease activate various signaling pathways that lead to cellular hypertrophy, fibroblast proliferation, and complex alterations of the extracellular matrix (ECM), such as tissue fibrosis; these may lead to disruption of the electrical side-toside junctions between muscle bundles [1], resulting in electrical dissociation. Cardiomyocytes and cardiac fibroblasts are 2 major myocardial cell types, which constitute o50% and 40–60% of the total cell population, respectively [2,3]. In normal adult hearts, quiescent fibroblasts substantially outnumber myocytes, and in response to hemodynamic stress or injury, these fibroblasts differentiate into myofibroblasts that proliferate, secrete collagen, and synthesize new proteins such as α-smooth muscle actin (α-SMA), stretch-sensitive ion channels, and connexins [4]. Fibroblasts have arrhythmogenic properties such as those involved in blocking impulse propagation and differentiation into myofibroblasts, which have contractility, have electrical connectivity and stimulate electrical impulse. The alteration of fibroblast-induced electrical impulses depends on the number of fibroblasts: small numbers of fibroblasts lead to slow impulse conduction whereas large numbers of fibroblasts lead to conduction block [5]. Recently,
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