Aldosterone and the Mineralocorticoid Receptor in Atrial Fibrillation

Area of Science:

• Cardiology
• Endocrinology
• Molecular Medicine

Background:

• Atrial fibrillation (AF) is a prevalent arrhythmia linked to stroke and heart failure.
• Pathophysiology involves atrial remodeling, increasing arrhythmia risk.
• Current treatments lack specific approaches targeting the proarrhythmic substrate.

Purpose of the Study:

• To review the role of aldosterone and mineralocorticoid receptor (MR) in atrial fibrillation pathogenesis.
• To summarize mechanistic evidence linking aldosterone to atrial remodeling and arrhythmia.
• To discuss the therapeutic potential of MR antagonists in AF prevention and treatment.

Main Methods:

• Review of clinical and experimental studies on aldosterone, MR, and atrial fibrillation.
• Analysis of mechanistic data on cellular processes modulated by MR activation.
• Synthesis of evidence on the efficacy of MR antagonists in various patient populations.

Main Results:

• Elevated aldosterone levels correlate with increased AF risk.
• MR antagonists reduce AF onset in diverse patient groups and may decrease recurrence in existing AF.
• Experimental studies confirm aldosterone's role in atrial inflammation, fibrosis, and arrhythmogenesis via MR activation.

Conclusions:

• Aldosterone and MR play a critical role in atrial fibrillation pathogenesis.
• MR activation drives atrial remodeling, inflammation, and fibrosis, contributing to AF.
• MR antagonists represent a promising therapeutic strategy for preventing and treating atrial fibrillation.