Microbes and their Role in Atrial Fibrillation: A Literature Review

Abstract

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia observed in clinical practice. The gut microbiota (GM) and their byproducts have the potential to activate the autonomic nervous system, which plays a crucial role in the development and maintenance of AF. Recent hypotheses suggest that bacterial infections, such as Helicobacter pylori and Chlamydia pneumonia might play a role in the development of AF. The emerging evidence suggested that certain patients might develop AF due to bacterial infections. AF patients exhibited a significant increase in species richness and diversity. Specifically, opportunistic pathogenic bacteria such as Klebsiella, Haemophilus, Streptococcus and Enterococcus were significantly higher, while symbiotic bacteria such as Agathobacter and Butyrivibrio were significantly lower in AF patients. Likewise, the development of AF has been linked to infections caused by viruses that have an affinity for the heart. Chronic hepatitis C virus infection appears to be linked to an elevated risk of incidental AF, likely due to the shared underlying pathology of chronic inflammation. Numerous studies have explored the arrhythmogenic effects of SARS-CoV-2, particularly its impact on mortality and its association with AF. Influenza infection was found to be significantly linked to the development of AF, resulting in an 18% increased risk. However, in cases where AF is present and dengue infection is suspected, it is advisable to exercise caution when considering the use of anticoagulants, ensuring that specific serological tests have excluded the presence of this infection.