How does chronic hypertension contribute to atrial fibrillation?

Chronic hypertension leads to significant structural changes in the heart, particularly affecting the atria. Over time, with sustained high blood pressure, the left atrium can undergo remodeling, resulting in an increase in size, also termed atrial dilation. This dilation creates an environment more conducive to the development of atrial fibrillation.

Additionally, hypertension is associated with the deposition of fibrotic tissue within the atrial myocardium. The presence of fibrosis disrupts the normal electrical conduction pathways, which can lead to re-entrant circuits and ectopic foci that trigger and sustain atrial fibrillation. The combination of increased atrial size and fibrosis not only predisposes the heart to arrhythmias but also contributes to the complexity of the electrical signals that need to be properly coordinated for effective pumping action.

While changes in heart rate variability and potential development of bradycardia can occur in patients with hypertension, they are not directly linked to the progression towards atrial fibrillation in the same manner that atrial remodeling is. Strengthening of the heart muscle is more often associated with conditions leading to hypertrophy (which could happen in heart failure situations) but does not inherently relate to the atrial fibrillation pathway from chronic hypertension.