Zheng Edward, Warchoł Izabela, Mejza Maja, Możdżan Maria, Strzemińska Monika, Bajer Anna, Madura Paulina, Żak Juliusz, Plewka Michał
Department of Interventional Cardiology and Heart Rhythm Diseases, Teaching Hospital No.2 of Medical University of Lodz, Faculty of Medicine, Medical University of Lodz, Zermoskiego 114, 91-647 Lodz, Poland.
J Clin Med. 2025 Jan 29;14(3):882. doi: 10.3390/jcm14030882.
Inflammation has been widely recognized as one of the major pathophysiological drivers of the development of atrial fibrillation (AF), which works in tandem with other risk factors of AF including obesity, diabetes, hypertension, and heart failure (HF). Our current understanding of the role of inflammation in the natural history of AF remains elusive; however, several key players, including the NLRP3 (NLR family pyrin domain containing 3) inflammasome, have been acknowledged to be heavily influential on chronic inflammation in the atrial myocardium, which leads to fibrosis and eventual degradation of its electrical function. Nevertheless, our current methods of pharmacological modalities with reported immunomodulatory properties, including well-established classes of drugs e.g., drugs targeting the renin-angiotensin-aldosterone system (RAAS), statins, and vitamin D, have proven effective in reducing the overall risk of developing AF, the onset of postoperative atrial fibrillation (POAF), and reducing overall mortality among patients with AF. This might bring hope for further progress in developing new treatment modalities targeting cellular checkpoints of the NLRP3 inflammasome pathway, or revisiting other well-known anti-inflammatory drugs e.g., colchicine, vitamin C, nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticosteroids, and antimalarial drugs. In our review, we aim to find relevant upstream anti-inflammatory treatment methods for the management of AF and present the most current real-world evidence of their clinical utility.
炎症已被广泛认为是心房颤动（AF）发生发展的主要病理生理驱动因素之一，它与AF的其他危险因素协同作用，包括肥胖、糖尿病、高血压和心力衰竭（HF）。我们目前对炎症在AF自然病程中作用的理解仍然模糊不清；然而，包括NLRP3（含NLR家族吡咯结构域3）炎性小体在内的几个关键因素，已被认为对心房心肌的慢性炎症有重大影响，进而导致纤维化并最终使其电功能退化。尽管如此，我们目前具有免疫调节特性的药物治疗方法，包括已确立的几类药物，如靶向肾素 - 血管紧张素 - 醛固酮系统（RAAS）的药物、他汀类药物和维生素D，已被证明在降低发生AF的总体风险、术后心房颤动（POAF）的发生率以及降低AF患者的总体死亡率方面是有效的。这可能为开发针对NLRP3炎性小体途径细胞检查点的新治疗方法，或重新审视其他知名的抗炎药物，如秋水仙碱、维生素C、非甾体抗炎药（NSAIDs）、糖皮质激素和抗疟药物带来进一步进展的希望。在我们的综述中，我们旨在寻找用于管理AF的相关上游抗炎治疗方法，并展示其临床应用的最新真实世界证据。
