ATRIAL FIBRILLATION: A REVIEW OF CONTEMPORARY EPIDEMIOLOGY AND ROLE OF INFLAMMATION IN THE PATHOPHYSIOLOGY.

Abstract

Background: Atrial Fibrillation (AF) is the most common form of sustained arrhythmia observed in clinical practice, and the incidence is rising in both developing and developed countries. It has been noted to contribute a major quota to the disability and death associated with cardiovascular diseases worldwide. Studies have shown that the pathophysiology of AF broadly revolves around electrical remodeling of the cardiac musculature, structural remodeling, calcium ion handling abnormalities, and autonomic nerve activation/remodeling. However, newer entities like inflammatory markers are emerging. Objective: The paper aims to review the current epidemiology of AF and the role of inflammatory markers in the pathogenesis of the condition. Methodology: This is a narrative review of the literature. We reviewed the contemporary epidemiology, pathophysiology, with a focus on the role of inflammatory markers such as interleukin-2, interleukin-6, C-reactive protein, and tumor necrosis factor. Results: Atrial fibrillation affects about 52.55 million individuals worldwide; prevalence and incidence increased by 137% and 124% between 1990 and 2021. The role of inflammation in the pathogenesis of AF and atrial flutter is increasingly being recognised. Elevated CRP predicts an increased risk of developing AF. TNF is associated with the pathogenesis of chronic AF, and levels in the plasma and left atrial tissue have a positive correlation with left atrial diameter. On the other hand, low IL-2 levels are associated with reduced incidence of postoperative AF. Interleukin 6 is associated with the generation and perpetuation of AF, and high levels correlate with the presence and duration of AF, as well as associated with the occurrence of AF post coronary artery bypass graft. Conclusion: Inflammatory markers are associated with increased incidence and prevalence of AF. Targeting this may offer novel insights into the prevention and treatment, thereby potentially reducing complications and improving patient outcomes in diverse settings.