The role of inflammation in the pathogenesis and treatment of arrhythmias

Abstract

The pathogenesis of arrhythmias is complex and multifactorial. The role of inflammation in the pathogenesis of both atrial and ventricular arrhythmias (VA) has been explored. However, developing successful pharmacotherapy regimens based on those pathways has proven more of a challenge. This narrative review provides an overview of five common arrhythmias impacted by inflammation, including atrial fibrillation (AF), myocardial infarction, arrhythmogenic cardiomyopathy, cardiac sarcoidosis, and QT prolongation, and the potential role for anti‐inflammatory therapy in their management. We identified arrhythmias and arrhythmogenic disease states with the most evidence linking pathogenesis to inflammation and conducted comprehensive searches of United States National Library of Medicine MEDLINE® and PubMed databases. Although a variety of agents have been studied for the management of AF, primarily in an effort to reduce postoperative AF following cardiac surgery, no standard anti‐inflammatory agents are used in clinical practice at this time. Although inflammation following myocardial infarction may contribute to the development of VA, there is no clear benefit with the use of anti‐inflammatory agents at this time. Similarly, although inflammation is clearly linked to the development of arrhythmias in arrhythmogenic cardiomyopathy, data demonstrating a benefit with anti‐inflammatory agents are limited. Cardiac sarcoidosis, an infiltrative disease eliciting an immune response, is primarily treated by immunosuppressive therapy and steroids, despite a lack of primary literature to support such regimens. In this case, anti‐inflammatory agents are frequently used in clinical practice. The pathophysiology of arrhythmias is complex, and inflammation likely plays a role in both onset and duration, however, for most arrhythmias the role of pharmacotherapy targeting inflammation remains unclear.

Mechanistic Insights Into Inflammation-Induced Arrhythmias: A Simulation Study

“…The generated pseudo-ECG of the human ventricular 2-D slice model under physiological and inflammatory conditions is shown in Figure 8 . As some available studies concerning systemic inflammation have reported ( Adlan et al, 2015 ; Lazzerini et al, 2020a ; Armbruster et al, 2022 ), prolonged QT intervals were also reproduced in our simulation results.…”

Radiofrequency Ablation in Patients Undergoing Mitral Valve Surgery with or without Giant Left Atria

“…On one hand, GLA patients had higher incidence of reoperation for postoperative bleeding, and although Armbruster et al considered cardiac surgery induced acute-phase inflammatory states precipitating AF, we do not believe that postoperative thoracotomy for hemostasis significantly increases the risk of AF recurrence. 21) On the other hand, it has been described that rheumatic etiology significantly decreased the success rate of RFA in patients undergoing MV surgery, 22 but in our analysis, there was no significant difference in the proportion of rheumatic cause between the patients with or without giant LA after PS matching. Furthermore, AF or AFL recurrence did not increase TE risk in with GLA in a subgroup analysis.…”

Fir(e)ing the Rhythm

“…Despite the wealth of preclinical and observational data, however, there are very limited data regarding anti-inflammatory therapies in patients with cardiac arrhythmias. 201 Indirect evidence of a benefit may be inferred from nonspecific anti-inflammatory treatments, such as statins, which suggest, although do not prove, a benefit of inhibiting inflammation. A study evaluating the effect of statins in patients with ICD found that those who had higher statin usage had a significantly reduced risk of SCD or VAs compared with those who had lower statin use.…”