Therapeutic Potential of Exosome for Cardiac Arrhythmia: A Systematic Review of Preclinical Evidence

Cardiac arrhythmias remain a major global health concern despite advances in therapeutic strategies. In certain clinical contexts, novel and minimally invasive therapies are particularly desirable. Exosomes have emerged as a promising approach for various diseases, but their therapeutic role in arrhythmias remains underexplored. This systematic review aims to synthesize and evaluate current evidence on the potential of exosome-based therapy for cardiac arrhythmias.

A comprehensive literature search was conducted in PubMed, ScienceDirect, and SCOPUS in accordance with PRISMA guidelines, using the search terms: (exosome) AND ((cardiac conduction) OR (arrhythmia)). Studies were included if they investigated the acute or mid-term effects of exosome therapy on cardiac conduction or arrhythmia incidence in animal models, and reported at least one relevant electrophysiological or arrhythmic outcome. Descriptive studies, biomarker-only evaluations, and studies not examining exosomes as a therapeutic intervention were excluded.

The initial search yielded 759 articles (259 from PubMed, 394 from SCOPUS, 106 from ScienceDirect). After removing 68 duplicates and screening titles and abstracts, 77 articles were selected for full-text review. Eighteen studies met the inclusion criteria. Most reported favorable outcomes, including reduced arrhythmia inducibility, improved or restored cardiac conduction, and enhanced overall cardiac function.

Preclinical evidence suggests that exosome therapy is potentially effective in reducing arrhythmia burden and improving cardiac electrophysiology, with a favorable safety profile in animal models. Further research is needed to understand its mechanisms deeper, optimize delivery methods, and assess its applicability in human populations.