Recent preclinical and observational cohort studies have implicated imbalances in gut microbiota composition as a contributor to atrial fibrillation (AF). The gut microbiota is a complex and dynamic ecosystem containing trillions of microorganisms, which produces bioactive metabolites influencing host health and disease development. In addition to host-specific determinants, lifestyle-related factors such as diet and drugs are important determinants of the gut microbiota composition. In this review, we discuss the evidence suggesting a potential bidirectional association between AF and gut microbiota, identifying gut microbiota-derived metabolites as possible regulators of the AF substrate. We summarize the effect of gut microbiota on the development and progression of AF risk factors, including heart failure, hypertension, obesity, and coronary artery disease. We also discuss the potential anti-arrhythmic effects of pharmacological and diet-induced modifications of gut microbiota composition, which may modulate and prevent the progression to AF. Finally, we highlight important gaps in knowledge and areas requiring future investigation. Although data supporting a direct relationship between gut microbiota and AF are very limited at the present time, emerging preclinical and clinical research dealing with mechanistic interactions between gut microbiota and AF is important as it may lead to new insights into AF pathophysiology and the discovery of novel therapeutic targets for AF.

中文翻译：

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肠道微生物群、菌群失调和心房颤动。心律失常机制和潜在的临床意义


最近的临床前和观察性队列研究表明，肠道微生物群组成失衡是导致心房颤动 (AF) 的一个因素。肠道微生物群是一个复杂而动态的生态系统，包含数万亿微生物，产生影响宿主健康和疾病发展的生物活性代谢物。除了宿主特异性决定因素外，饮食和药物等生活方式相关因素也是肠道微生物群组成的重要决定因素。在这篇综述中，我们讨论了表明 AF 和肠道微生物群之间潜在双向关联的证据，确定肠道微生物群衍生的代谢物作为 AF 底物的可能调节剂。我们总结了肠道微生物群对 AF 危险因素（包括心力衰竭、高血压、肥胖和冠状动脉疾病）发生和进展的影响。我们还讨论了药物和饮食诱导的肠道微生物群组成改变的潜在抗心律失常作用，这可能调节和预防房颤的进展。最后，我们强调了知识方面的重要差距和需要未来研究的领域。尽管目前支持肠道微生物群与房颤之间直接关系的数据非常有限，但新兴的涉及肠道微生物群与房颤之间机制相互作用的临床前和临床研究非常重要，因为它可能会带来对房颤病理生理学的新见解，并发现新的治疗方法。 AF 的治疗目标。