New directions in antiarrhythmic drug therapy for atrial fibrillation

Author:

Heijman Jordi1,Voigt Niels12,Dobrev Dobromir3

Affiliation:

1. Institute of Pharmacology, Medical Faculty Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany

2. Division of Experimental Cardiology, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany

3. DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.

Abstract

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and has a significant impact on morbidity and mortality. Current antiarrhythmic drugs for AF suffer from limited safety and efficacy, probably because they were not designed based on specific pathological mechanisms. Recent research has provided important insights into the mechanisms contributing to AF and highlighted several potential novel antiarrhythmic strategies. In this review, we highlight the main pathological mechanisms of AF, discuss traditional and novel aspects of atrial antiarrhythmic drugs in relation to these pathological mechanisms, and present potential novel therapeutic approaches including structure-based modulation of atrial-specific cardiac ion channels, restoring abnormal Ca2+ handling in AF and targeting atrial remodeling.

Publisher

Future Medicine Ltd

Subject

Cardiology and Cardiovascular Medicine,Molecular Medicine

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