Metabolomics in atrial fibrillation - A review and meta-analysis of blood, tissue and animal models

Atrial fibrillation (AF) is a highly prevalent cardiac arrhythmia associated with severe cardiovascular complications. AF presents a growing global challenge, however, current treatment strategies for AF do not address the underlying pathophysiology. To advance diagnosis and treatment of AF, a deeper understanding of AF root causes is needed. Metabolomics is a fast approach to identify, quantify and analyze metabolites in a given sample, such as human serum or atrial tissue. In the past two decades, metabolomics have enabled research on metabolite biomarkers to predict AF, metabolic features of AF, and testing metabolic mechanisms of AF in animal models. Due to the field's rapid evolution, the methods of AF metabolomics studies have not always been optimal. Metabolomics research has lacked standardization and requires expertise to face methodological challenges. We summarize and meta-analyze metabolomics research on AF in human plasma and serum, atrial tissue, and animal models. We present the current progress on metabolic biomarkers candidates, metabolic features of clinical AF, and the translation of metabolomics findings from animal to human. We additionally discuss strengths and weaknesses of the metabolomics method and highlight opportunities for future AF metabolomics research. [Display omitted] •Potential AF biomarkers are acylcarnitines, acisoga, caffeine, glycerol and uridine.•Sixteen metabolites are significantly altered in AF, as determined by false discovery rate analysis.•Atrial metabolomics studies are limited and do not provide consensus on AF ketone and glucose metabolism.•An AF sheep model shows increased glycolysis and gluconeogenesis.