Upstream effect for atrial fibrillation: still a dilemma?

Abstract

Atrial fibrillation is the most common arrhythmia in clinical practice. Ion channel blocking agents are often characterized by limited long-term efficacy and several side effects. In addition, ablative invasive procedures are neither easily accessible nor always efficacious. The "upstream therapy," which includes angiotensin-converting enzyme inhibitors, aldosterone receptor antagonists, statins, glucocorticoids, and ω-3 poly-unsaturated fatty acids, targets arrhythmia substrate, influencing atrial structural and electrical remodeling that play an essential role in atrial fibrillation induction and maintenance. The mechanisms involved and the most important clinical evidence regarding the upstream therapy influence on atrial fibrillation are presented in this review. Some open questions are also proposed.

• Authors: Leonardo Calò, Annamaria Martino, Luigi Sciarra, Antonio Ciccaglioni, Ermenegildo De Ruvo, Lucia De Luca, Antonella Sette, Giuseppe Giunta, Ernesto Lioy, Francesco Fedele
• Journal: Pacing and clinical electrophysiology : PACE (Pacing Clin Electrophysiol) Vol. 34 Issue 1 Pg. 111-28 (Jan 2011) ISSN: 1540-8159 [Electronic] United States
• PMID: 21029134 (Publication Type: Journal Article, Review)
• Copyright: ©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.

Chemical References

• Angiotensin-Converting Enzyme Inhibitors
• Anti-Arrhythmia Agents
• Fatty Acids, Omega-3
• Glucocorticoids
• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (drug therapy)
• Fatty Acids, Omega-3 (therapeutic use)
• Glucocorticoids (therapeutic use)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)