Aldosterone-receptor antagonism as a potential therapeutic option for atrial fibrillation.
Recent research provided important insights into the development of atrial fibrillation (AF)-maintaining substrate and suggested targeting of the underlying molecular mechanisms, 'upstream' of the electrical aspects of AF, as a novel strategy for AF treatment ('upstream' therapy). Upstream therapies for AF include drugs targeting the renin-angiotensin II-aldosterone system (angiotensin converting enzyme inhibitors and AT(1) receptor antagonists and aldosterone antagonists), statins, steroids and omega-3 fatty acids (fish oil). Aldosterone causes volume retention, cardiac hypertrophy and fibrosis, and systemic inflammation and coagulation that promote AF development and its complications and blockade of aldosterone receptors with spironolactone or eplerenone suppresses inducible AF. Although the clinical impact of spironolactone treatment requires validation in randomized clinical trials in AF patients, further understanding of the molecular mechanisms by which aldosterone causes atrial remodelling is likely to lead to development of novel therapeutic approaches to AF.
Lendeckel
Uwe
U
Institute of Medical Biochemistry and Molecular Biology, Ernst-Moritz-Arndt University Greifswald, Germany.
Dobrev
Dobromir
D
Goette
Andreas
A
D001281:Atrial Fibrillation / Q000188:drug therapy*; D000077545:Eplerenone; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone
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