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Upstream Effect for Atrial Fibrillation: Still a Dilemma?
Author(s) -
CALÒ LEONARDO,
MARTINO ANNAMARIA,
SCIARRA LUIGI,
CICCAGLIONI ANTONIO,
DE RUVO ERMENEGILDO,
DE LUCA LUCIA,
SETTE ANTONELLA,
GIUNTA GIUSEPPE,
LIOY ERNESTO,
FEDELE FRANCESCO
Publication year - 2011
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2010.02942.x
Subject(s) - medicine , atrial fibrillation , cardiology , supraventricular arrhythmia , aldosterone , cardiac arrhythmia
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. (PACE 2011; 111–128)