The Emerging Role of Inflammation and Fibrosis in Atrial Fibrillation and the Potential of Counter Interventions

Abstract

There are now emerging data to support the association between in?¬?ammation and atrial fibrillation (AF). Initial observations were made after coronary artery bypass surgery, noting a peak incidence of AF on the second and third post-operative days, which coincided with the peak elevation of CRP levels. This association was subsequently shown in several other situations of AF. Data also emerge which link the renin-angiotensin aldosterone system (RAAS) to this inflammatory process. A putative link between in?¬?ammation and thromboembolic complications of AF has also been suspected. Given the important role of the RAAS in in?¬?ammation and AF, it could be postulated that interruption of the RAAS may exert positive effects upon this process. Statins with their anti-inflammatory action as part of their pleiotropic effects, as well as other anti-inflammatory agents, such as steroids and fish oils,  might be of help in AF therapy according to some clinical studies. Finally, there appears to be a connection with atrial fibrosis in AF, as increased atrial ?¬brosis has been shown to correspond to an increase in conduction heterogeneity and AF vulnerability. Thus, inflammation and fibrosis may constitute new therapeutic targets in the management of AF. More studies are needed to clarify these important issues.