Therapeutic options for patients with advanced atrial fibrillation: from lifestyle and medication to catheter and surgical ablation

Abstract

Atrial fibrillation (AF) is part of a vicious cycle that includes multiple cardiovascular risk factors and comorbidity which can promote atrial remodelling and AF progression. Most AF-related risk factors-hypertension, diabetes, sleep apnoea, obesity and sedentary lifestyle-are in essence modifiable which may prevent AF development. Treatment of associated cardiovascular conditions may prevent both symptoms and future cardiovascular events. For advanced forms of symptomatic AF refractory to lifestyle management and optimal medication, invasive ablation therapies have become a cornerstone. Although electrical trigger isolation from the pulmonary veins is reasonably effective and safe, more potent energy sources including high output-short duration radiofrequency, ultra-low cryo-energy, and electroporation, as well as more sophisticated arrays, balloons, and lattice-tipped catheter tools, are on their way to eliminate existing pitfalls and simplify the procedure. Electroanatomical navigation and mapping systems are becoming available to provide real-time information on ablation lesion quality and the critical pathways of AF in the individual patient to guide more extensive ablation strategies that may enhance longterm outcome for freedom of advanced AF. Surgi

Radiofrequency catheter ablation combined with spironolactone in the treatment of atrial fibrillation: A single‐center randomized controlled study

“…Mayyas et al posited that ALD antagonists may be more helpful in preventing the progression of AF than in suppressing the onset of AF; this suggests that ALD has a greater effect on AF substrate than triggers 8 . Electrical isolation of the pulmonary veins (PVI) was found to prevent AF by effectively eliminating triggers, which remains the cornerstone for ablation treatment 15 . Therefore, CPVI combined with spironolactone is expected to improve atrial fibrosis and reduce the recurrence rate of atrial fibrillation.…”

“… 8 Electrical isolation of the pulmonary veins (PVI) was found to prevent AF by effectively eliminating triggers, which remains the cornerstone for ablation treatment. 15 Therefore, CPVI combined with spironolactone is expected to improve atrial fibrosis and reduce the recurrence rate of atrial fibrillation. The results of this study showed a significant decrease in the inner diameter of the left atrium in Group PVI/SP (p < .001), and this diameter was smaller than in Group PVI alone (p < .05).…”

Natural Compounds as Guides for the Discovery of Drugs Targeting G-Protein-Coupled Receptors

“…The percentage of approved drugs (in human therapy) targeting GPCRs is estimated to be 35-45% as there are drugs from different pharmaceutical companies that have the same goal, that is to reach the same receptor. Therefore, there are hopes that the remaining 90% of GPCRs can become a target of future drugs, especially for diseases for which there is no efficacious medication; two examples are Alzheimer's disease [2] and atrial fibrillation [3][4][5].…”