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Biological therapies that increase or suppress the expression of transcripts underlying atrial fibrillation (AF) progression are increasingly being explored to create novel treatment paradigms beyond simply suppressing or destroying tissue. To date, there has been no systematic overview of the pre-clinical evidence exploring manipulation of fundamental biological principles in the treatment of AF. As such, the objective of this study was to establish the effect of biological approaches used in the treatment of AF within large and small animals. We performed a systematic search using predefined terms which yielded 25 studies. We determined the effect of biological approaches on primary efficacy outcomes and assessed the quality of included studies or possible bias in the treatment of AF. Compared to controls, biological therapies reduced AF inducibility (85% less AF (OR 0.15, 95%CI 0.07-0.35, p<0.01)) and atrial scar burden (6.7% smaller scars (95% CI 4.2-9.2, p<0.01)) or increased the number of days in sinus rhythm (6.4 more days in sinus rhythm (95%CI 5.83-6.97, p<0.01). Similar effects were seen in both large and small animals while a minor tendency to greater risk for bias was observed in small animal studies. In conclusion, treatment with any biological therapy significantly improved AF in preclinical animal models compared to controls. Although biological therapies target markedly different fundamental mechanisms, we observed a consistent difference in their effect on AF outcomes.
This article was published in the following journal.
Name: Heart rhythm
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Rapid, irregular atrial contractions caused by a block of electrical impulse conduction in the right atrium and a reentrant wave front traveling up the inter-atrial septum and down the right atrial free wall or vice versa. Unlike ATRIAL FIBRILLATION which is caused by abnormal impulse generation, typical atrial flutter is caused by abnormal impulse conduction. As in atrial fibrillation, patients with atrial flutter cannot effectively pump blood into the lower chambers of the heart (HEART VENTRICLES).
Long-term changes in the electrophysiological parameters and/or anatomical structures of the HEART ATRIA that result from prolonged changes in atrial rate, often associated with ATRIAL FIBRILLATION or long periods of intense EXERCISE.
A cardiotonic glycoside obtained mainly from Digitalis lanata; it consists of three sugars and the aglycone DIGOXIGENIN. Digoxin has positive inotropic and negative chronotropic activity. It is used to control ventricular rate in ATRIAL FIBRILLATION and in the management of congestive heart failure with atrial fibrillation. Its use in congestive heart failure and sinus rhythm is less certain. The margin between toxic and therapeutic doses is small. (From Martindale, The Extra Pharmacopoeia, 30th ed, p666)
Impaired or delayed impulse conduction between the right and left HEART ATRIA. Advanced interatrial blocks are often associated with arrhythmias (e.g., ATRIAL FLUTTER; and ATRIAL FIBRILLATION), direct conduction block via the Bachmann's bundle and concomitant left atrial enlargement. Syndrome of advanced interatrial block associated with SUPRAVENTRICULAR TACHYCARDIA is referred to as Bayes syndrome.
A THROMBIN inhibitor which acts by binding and blocking thrombogenic activity and the prevention of thrombus formation. It is used to reduce the risk of stroke and systemic EMBOLISM in patients with nonvalvular atrial fibrillation.
Biological therapy involves the use of living organisms, substances derived from living organisms, or laboratory-produced versions of such substances to treat disease. Some biological therapies for cancer use vaccines or bacteria to stimulate the body&rs...