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©2013 UpToDate ® Print Email AF remodeling Mechanisms underlying ATR. Rapid atrial rates increase potentially cytotoxic Ca 2+ loading. Autoprotective I Ca,L reductions occur via rapidly developing functional changes (I Ca,L inactivation) and more slowly developing changes in gene and protein expression. Decreased I Ca,L reduces Ca 2+ loading but decreases APD. Diminished APD shortens refractoriness and reduces the wavelength (WL), which allows for smaller and more atrial reentry circuits, thus making AF unlikely to terminate. Atrial tachycardia also increases inward-rectifier currents such as I K1 and I K,ACh,c , which further reduces APD and promotes AF. RP: refractory period; WL: wavelength. Reproduced with permission from: Nattel S, Burstein B, Dobrev D. Atrial Remodeling and Atrial Fibrillation: Mechanisms and Implications. Circ Arrhythm Electrophysiol 2008; 1:62. Copyright © 2008 Lippincott Williams & Wilkins.