I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, Roma 00161, Italy
I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, Roma 00161, Italy.
Europace. 2014 Aug;16(8):1107-16. doi: 10.1093/europace/euu040. Epub 2014 Apr 4.
Atrial fibrillation (AF) is a self-perpetuating arrhythmia which is dependent upon structural and functional changes elicited by atrial high rate activity. Shortening of atrial effective refractory period is the earliest functional change which characterizes atrial remodelling. Studies in humans demonstrated oxidant species overproduction in the cardiac specimens from patients with AF and a significant association between reactive oxidant species (ROS) formation and risk of AF. Also, there is experimental evidence to suggest that ROS may be implicated not only in promoting AF but also in maintaining atrial arrhythmia. Several enzymatic pathways seem to be implicated in ROS overproduction, which ultimately leads to enhanced vulnerability to AF; they include myeloperoxidase, Nicotinamide adenine dinucleotide phosphate oxidase, and uncoupled nitric oxide synthase enzymes. To explore if ROS are implicated in promoting AF experimental studies with antioxidants, prevalently antioxidant vitamins such as ascorbic acid and vitamin E, have been planned. Furthermore, interventional trials have been carried out with antioxidants in clinical settings characterized by enhanced risk of AF. This review reports on experimental and clinical studies exploring the role of ROS in eliciting the occurrence or recurrence of AF and the potential efficacy of a treatment by antioxidant vitamins; furthermore, we performed a meta-analysis of the interventional trials in patients at risk of AF to see if antioxidant treatment is able to reduce the AF occurrence.
心房颤动（AF）是一种自我维持的心律失常，依赖于由心房高心率活动引起的结构和功能变化。心房有效不应期缩短是最早的功能变化，其特征是心房重构。人类研究表明，AF 患者的心脏标本中超氧化物的产生增加，并且活性氧（ROS）形成与 AF 的风险之间存在显著相关性。此外，有实验证据表明，ROS 不仅可能参与促进 AF，而且可能参与维持心房性心律失常。几种酶促途径似乎与 ROS 的过度产生有关，这最终导致对 AF 的易感性增强；它们包括髓过氧化物酶、烟酰胺腺嘌呤二核苷酸磷酸氧化酶和非偶联的一氧化氮合酶。为了探讨 ROS 是否参与促进 AF，计划进行了抗氧化剂的实验研究，主要使用抗氧化维生素，如抗坏血酸和维生素 E。此外，在具有增强 AF 风险的临床环境中进行了抗氧化剂的干预试验。本综述报告了探索 ROS 在引发 AF 发生或复发中的作用的实验和临床研究，以及抗氧化维生素治疗的潜在疗效；此外，我们对 AF 风险患者的干预试验进行了荟萃分析，以观察抗氧化治疗是否能够降低 AF 的发生。
