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新型抗心律失常药物治疗心房颤动。

Emerging Antiarrhythmic Drugs for Atrial Fibrillation.

机构信息

West German Heart and Vascular Center, Institute of Pharmacology, University Duisburg-Essen, 45147 Essen, Germany.

Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2400 Copenhagen, Denmark.

出版信息

Int J Mol Sci. 2022 Apr 7;23(8):4096. doi: 10.3390/ijms23084096.

Abstract

Atrial fibrillation (AF), the most common cardiac arrhythmia worldwide, is driven by complex mechanisms that differ between subgroups of patients. This complexity is apparent from the different forms in which AF presents itself (post-operative, paroxysmal and persistent), each with heterogeneous patterns and variable progression. Our current understanding of the mechanisms responsible for initiation, maintenance and progression of the different forms of AF has increased significantly in recent years. Nevertheless, antiarrhythmic drugs for the management of AF have not been developed based on the underlying arrhythmia mechanisms and none of the currently used drugs were specifically developed to target AF. With the increased knowledge on the mechanisms underlying different forms of AF, new opportunities for developing more effective and safer AF therapies are emerging. In this review, we provide an overview of potential novel antiarrhythmic approaches based on the underlying mechanisms of AF, focusing both on the development of novel antiarrhythmic agents and on the possibility of repurposing already marketed drugs. In addition, we discuss the opportunity of targeting some of the key players involved in the underlying AF mechanisms, such as ryanodine receptor type-2 (RyR2) channels and atrial-selective K-currents ( and ) for antiarrhythmic therapy. In addition, we highlight the opportunities for targeting components of inflammatory signaling (e.g., the NLRP3-inflammasome) and upstream mechanisms targeting fibroblast function to prevent structural remodeling and progression of AF. Finally, we critically appraise emerging antiarrhythmic drug principles and future directions for antiarrhythmic drug development, as well as their potential for improving AF management.

摘要

心房颤动(AF)是全球最常见的心律失常,其驱动机制在不同患者亚组之间存在差异,具有复杂性。这种复杂性表现在 AF 呈现的不同形式(术后、阵发性和持续性)中,每种形式都具有异质的模式和不同的进展。近年来,我们对引发、维持和进展不同形式 AF 的机制的理解有了显著提高。然而,用于治疗 AF 的抗心律失常药物并未基于潜在的心律失常机制开发,目前使用的药物中没有一种是专门针对 AF 开发的。随着对不同形式 AF 潜在机制的认识不断增加,开发更有效和更安全的 AF 治疗方法的新机会正在出现。在这篇综述中,我们根据 AF 的潜在机制概述了潜在的新型抗心律失常方法,既关注新型抗心律失常药物的开发,也关注已有药物的再利用的可能性。此外,我们还讨论了针对 AF 潜在机制中一些关键参与者的可能性,例如肌质网钙释放通道 RyR2 通道和心房选择性 K 电流( 和 )用于抗心律失常治疗。此外,我们强调了靶向炎症信号成分(例如 NLRP3 炎性小体)和靶向成纤维细胞功能的上游机制的机会,以预防 AF 的结构重构和进展。最后,我们批判性地评价了新兴的抗心律失常药物原则和抗心律失常药物开发的未来方向,以及它们在改善 AF 管理方面的潜力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f09e/9029767/004971b59c9c/ijms-23-04096-g001.jpg

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