Obstructive sleep and atrial fibrillation: Pathophysiological mechanisms and therapeutic implications

Goudis, Christos A.; Ketikoglou, Dimitrios G.

doi:10.1016/j.ijcard.2016.12.120

Cited by 95 publications

(57 citation statements)

References 121 publications

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“…Many plausible mechanisms have been proposed for this association. Goudis et al suggests that swings intrathoracic pressure, intermittent hypoxia, oxidative stress with endothelial dysfunction and autonomic imbalance with an increased sympathetic tone in OSA resulted in atrial enlargement and fibrosis causing conductions abnormalities contributed to AF …”

Section: Discussionmentioning

confidence: 99%

Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta‐analysis

Congrete

Bintvihok

Thongprayoon

et al. 2018

J Evidence Based Medicine

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Section: Discussionmentioning

confidence: 99%

Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta‐analysis

Congrete

Bintvihok

Thongprayoon

et al. 2018

J Evidence Based Medicine

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“…Moreover, obesity is a major risk factor for obstructive sleep apnea (OSA) a condition that further increases AF burden . In fact, OSA further aggravates neurohormonal, hemodynamic, and inflammatory abnormalities associated with atrial remodeling …”

Section: Risk Factors For Af and Inflammationmentioning

confidence: 99%

Inflammation and atrial fibrillation: A comprehensive review

Korantzopoulos

Letsas

Tse

et al. 2018

Journal of Arrhythmia

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146

106

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Atrial fibrillation (AF) has different underlying substrates. Atrial remodeling involves electrophysiological and structural abnormalities that promote the development and perpetuation of AF. Experimental and clinical data indicate that inflammation is implicated in the pathophysiology of atrial remodeling. The mechanistic links between atrial remodeling and inflammation are complex while diverse underlying diseases and conditions may affect these pathways. Inflammatory markers have also been associated with AF development, recurrence, perpetuation, total AF burden as well as with thromboembolic complications. The development of specific anti‐inflammatory interventions in this setting seems to be challenging and complicated. Several agents with pleiotropic properties, including anti‐inflammatory, have been tested in experimental and clinical settings with variable results. This updated review provides a concise overview of all available data regarding the role of inflammation in AF including the predictive role of inflammatory markers. Also, current knowledge and future directions on anti‐inflammatory strategies are critically discussed.

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“…Obesity increases the likelihood of AF with several mechanisms : 1) increases the risk of hypertension, diabetes, and CAD; 2) promotes the growth of epicardial fat, which is linked to local inflammation; 3) is often associated with obstructive sleep apnea (OSA) syndrome. OSA favors atrial volume overload, cause hypoxia and oxidative stress, and is linked with systemic inflammation, thus representing an independent risk factor for AF (Goudis and Ketikoglou, 2017).…”

Section: Systemic Inflammation Is Associated With Afmentioning

confidence: 99%

Pharmacological Inhibition of Serine Proteases to Reduce Cardiac Inflammation and Fibrosis in Atrial Fibrillation

et al. 2019

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Systemic inflammation correlates with an increased risk of atrial fibrillation (AF) and thrombogenesis. Systemic inflammation alters vessel permeability, allowing inflammatory and immune cell migration toward target organs, including the heart. Among inflammatory cells infiltrating the atria, macrophages and mast cell have recently attracted the interest of basic researchers due to the pathogenic mechanisms triggered by their activation. This chemotactic invasion is likely implicated in shortand long-term changes in cardiac cell-to-cell communication and in triggering fibrous tissue accumulation in the atrial myocardium and electrophysiological rearrangements of atrial cardiomyocytes, thus favoring the onset and progression of AF. Serine proteases are a large and heterogeneous class of proteases involved in several processes that are important for cardiac function and are involved in cardiac diseases, such as (i) coagulation, (ii) fibrinolysis, (iii) extracellular matrix degradation, (iv) activation of receptors (i.e., protease-activated receptors [PPARs]), and (v) modulation of the activity of endogenous signals. The recognition of serine proteases substrates and their involvement in inflammatory/profibrotic mechanisms allowed the identification of novel cardio-protective mechanisms for commonly used drugs that inhibit serine proteases. The aim of this review is to summarize knowledge on the role of inflammation and fibrosis as determinants of AF. Moreover, we will recapitulate current findings on the role of serine proteases in the pathogenesis of AF and the possible beneficial effects of drugs inhibiting serine proteases in reducing the risk of AF through decrease of cardiac inflammation and fibrosis. These drugs include thrombin and factor Xa inhibitors (used as oral anticoagulants), dipeptidyl-peptidase 4 (DPP4) inhibitors, used for type-2 diabetes, as well as novel experimental inhibitors of mast cell chymases.

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Obstructive sleep and atrial fibrillation: Pathophysiological mechanisms and therapeutic implications

Cited by 95 publications

References 121 publications

Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta‐analysis

Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta‐analysis

Inflammation and atrial fibrillation: A comprehensive review

Pharmacological Inhibition of Serine Proteases to Reduce Cardiac Inflammation and Fibrosis in Atrial Fibrillation

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