Nso Nso, Bookani Kaveh R, Metzl Mark, Radparvar Farshid
Department of Internal Medicine Division of Cardiology Icahn School of Medicine at Mount Sinai/Queens (Queens Hospital Center) Jamaica NY USA.
Department of Medicine Division of Cardiovascular Medicine (Northshore Program) University of Chicago Evanston IL USA.
J Arrhythm. 2020 Dec 23;37(1):1-10. doi: 10.1002/joa3.12473. eCollection 2021 Feb.
Atrial fibrillation (AF) is one of the most common cardiac disorders affecting adults and is associated with significant morbidity and mortality. Efforts to manage AF through anti-arrhythmics and rate control have been largely unsatisfactory. It has become clear that AF causes structural alterations in the atrial myocardium that propagate further AF, and that some of these alterations are the result of inflammation.
An in-depth review of the available literature was undertaken using Google Scholar and keyword searches including [Atrial fibrillation] in combination with [inflammatory markers], [myocardial fibrosis], and [immunomodulators], limiting the search to English language articles. All articles were reviewed for relevance and collated by the author.
Multiple markers of inflammation have been shown to be elevated in AF and to predict responses to treatments of AF including anti-arrhythmics and cardioversion. The nidus of inflammation is not clear but seems to be related to the pulmonary veins.
The inflammatory cascade induces fibrotic changes in the myocardium, an arrhythmogenic process that stimulates further inflammation. Advances in treatment are focusing on biological agents and immunomodulators that inhibit the inflammatory cascade.
心房颤动（AF）是影响成年人的最常见心脏疾病之一，与显著的发病率和死亡率相关。通过抗心律失常药物和心率控制来管理房颤的努力在很大程度上并不令人满意。现已明确，房颤会导致心房心肌发生结构改变，进而引发更多房颤，且其中一些改变是炎症所致。
利用谷歌学术进行深入的文献综述，并通过关键词搜索，搜索词包括[心房颤动]与[炎症标志物]、[心肌纤维化]和[免疫调节剂]的组合，将搜索范围限定为英文文章。作者对所有文章进行相关性审查并整理。
多项炎症标志物在房颤患者中已被证明升高，并可预测房颤治疗（包括抗心律失常药物治疗和心脏复律）的反应。炎症病灶尚不清楚，但似乎与肺静脉有关。
炎症级联反应会诱发心肌纤维化改变，这是一个致心律失常过程，会进一步刺激炎症。治疗进展正聚焦于抑制炎症级联反应的生物制剂和免疫调节剂。
