Oxidant and Inflammatory Mechanisms and Targeted Therapy in Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is an important cause of stroke and risk factor for heart failure and death. Current pharmacologic treatments for AF have limited efficacy, and treatments that more directly target the underlying causes of AF are needed. Oxidant stress and inflammatory activation are inter-related pathways that promote atrial electrical and structural remodeling, leading to atrial ectopy, interstitial fibrosis and increased stroke risk. This review evaluates the impact of common stressors on atrial oxidant stress and inflammatory activation, and the contribution of these pathways to atrial remodeling. Recent studies suggest that integrated efforts to target the underlying risk factors, rather than the AF per se, may have a greater impact on health and outcomes than isolated efforts focused on the electrical abnormalities.

The effect of statins on the recurrence rate of atrial fibrillation after catheter ablation: A meta‐analysis

“…Unfortunately, the extent of a systemic inflammatory response following catheter ablation was unclear. Many clinical trials, meta‐analyses, and guidelines admitted that oxidative stress and inflammatory activation had interrelated pathways that promoted electrical and structural atrial remodeling . Therefore, it may be strongly implicated at the AF onset.…”

“…Many clinical trials, meta-analyses, and guidelines admitted that oxidative stress and inflammatory activation had interrelated pathways that promoted electrical and structural atrial remodeling. 22 Therefore, it may be strongly implicated at the AF onset. Statins, which impact oxidative and inflammatory mechanisms, protect against electrical remodeling associated with atrial tachycardia pacing.…”

Effects of the short‐term exposure to ambient air pollution on atrial fibrillation

“…The underlying mechanism for the correlation between particular matter and AF has yet been clearly demonstrated. A great number of studies suggested that particular matter cause oxidative stress, cardiovascular inflammation, endothelial dysfunction, high C‐reactive protein level, cardiac ischemia, and right atrial pressure, which were all related to atrial remodeling and AF pathophysiology . In addition, acute autonomic imbalance associated with exposure to particular matter may also induce AF …”

“…A great number of studies suggested that particular matter cause oxidative stress, cardiovascular inflammation, endothelial dysfunction, high C-reactive protein level, cardiac ischemia, and right atrial pressure, 10,[23][24][25][26] which were all related to atrial remodeling and AF pathophysiology. [27][28][29][30] In addition, acute autonomic imbalance associated with exposure to particular matter may also induce AF. 31 Contrary to previous studies, we did not find significant asso- increasing hospitalizations and premature mortality.…”

Sodium-glucose co-transporter 2 inhibition as a mitochondrial therapy for atrial fibrillation in patients with diabetes?

“…Morphological and functional comparisons of atrial tissue from patients with or without diabetes have revealed that fibrosis was more elevated in diabetic atria [17]. Furthermore, atria from patients with T2DM and AF consistently display evidence for increased oxidative stress, suggesting that the oxidative stress and/ or underlying mechanisms may represent a T2DM-specific therapeutic target for AF [18,19].…”