A novel explanation for the cause of atrial fibrillation seen in atherosclerotic coronary artery disease: “Downstream inflammation” hypothesis

Atrial fibrillation is a frequent arrhythmia, and atherosclerotic coronary artery disease remains as the most common etiological factor underlying atrial fibrillation, along with systemic hypertension. The relationship between uncomplicated coronary artery disease and atrial fibrillation is not explained satisfactorily. Inflammation is now recognized as an important pathogenetic mechanism for both disorders. We hypothesise that inflammation originated from atherosclerotic coronary arteries may disseminate downstream to atrial tissue and initiate or stabilize atrial fibrillation. Studies conducted with drugs bearing anti-inflammatory properties such as hydroxymethylglutaryl coenzyme A inhibitors decrease frequency of both conditions. Such a relationship may become a novel therapeutic target to prevent this arrhythmia or decrease the frequency of paroxysms.