Upstream therapy of atrial fibrillation
Authors:
R. Lábrová; J. Špinar
Authors‘ workplace:
Interní kardiologická klinika LF MU a FN Brno
Published in:
Kardiol Rev Int Med 2011, 13(3): 160-166
Overview
Triggering ectopias and arrhytmogenic substrates that enable the preservation of atrial fibrillation are related to electrical, structural and subsequent mechanical remodelling of the atrial myocardium and are significantly affected by a number of modulating factors. The presence of atrial fibrillation itself accelerates the remodelling process. So called ‘upstream therapy’ interferes with the pathogenesis of atrial fibrillation as well as with the remodelling process and is administered in both primary and secondary preventive care. The renin-angiotensin-aldosterone system plays an important role in the pathogenesis and preservation of atrial fibrillation and significantly influences the process of electrical and structural remodelling. Effective inhibition of the renin-angiotensin-aldosterone system may help prevent the genesis and recurrence of atrial fibrillation, therefore reducing negative effects associated with the presence of atrial fibrillation. Upstream therapy is clearly indicated in patients with hypertension, particularly with left ventricle hypertrophy, and in cardiac failure patients with left ventricular dysfunction. In these cases therapy is indicated also without regard to atrial fibrillation. Evidence is less supportive of upstream therapy for patients with minimal structural impairment of the heart or in secondary preventive care. Statins with anti-inflammatory effects are indicated in the primary prevention of atrial fibrillation in post-operative conditions, particularly following coronary by-pass operations or valvular repairs. The introduction of statins may be considered for patients with heart failure, hypertension and ischaemic heart disease. Renin-angiotensin-aldosterone system blockers and statins are not indicated in primary prevention for patients without cardiovascular disease. The positive effects of various anti-inflammatory drugs, corticosteroids, polyunsaturated fatty acids and other substances on atrial fibrillation have not been proven and as such are not indicated in the upstream therapy concept.
Keywords:
atrial fibrillation – atrial remodelling – upstream therapy – angiotensin-converting enzyme inhibitors – angiotensin receptor blockers – statins – steroids – polyunsaturated fatty acids
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Labels
Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
Cardiology Review
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