Abstract: Atrial fibrillation (AF) is a multifactorial disease and the mechanisms that underlie AF are various. Long-term persistence of AF unavoidably causes structural remodeling changes; therefore, it is crucial to treat early electrical atrial remodeling as a target in anti-AF therapy. Here we reviewed the physiological bases of electrical atrial remodeling, the unique features of atrial intracellular Ca2+ management in AF patients and the novel medical treatments for AF.