The mechanism of electrical remodeling in atrial fibrillation and current research status of natural drugs and active ingredients inhibiting atrial electrical remodeling

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, with its incidence and mortality rates steadily increasing every year, posing a growing global health threat. During AF, high-frequency sustained electrical activity in atria induces electrophysiological changes. This process, known as atrial electrical remodeling (AER), in turn, plays a crucial role in both the initiation and maintenance of AF. Key contributors to AER include abnormalities in gene expression, alterations in electrophysiology, dysfunction of the ion channel, inflammatory responses, and oxidative stress. Natural compounds, primarily derived from plants and other natural resources, have attracted considerable attention for their high efficacy, low toxicity, and ability to target multiple therapeutic pathways. These compounds—such as matrine, berberine, ginsenosides, quercetin, icariin, and tanshinone—offer comprehensive regulatory effects that can effectively attenuate AER, providing unique therapeutic advantages in the management of AF. This review systematically synthesizes the mechanisms underlying AER and examines how natural drugs and their active ingredients can mitigate AF by inhibiting this remodeling process, offering valuable insights for the development of potentially effective natural therapeutics against AF.