Atrial-Selective Approaches for the Treatment of Atrial Fibrillation

Atrial-Selective Approaches for the Treatment of Atrial Fibrillation Joachim R. Ehrlich, Peter Biliczki, Stefan H. Hohnloser, Stanley Nattel Atrial-selective pharmacological approaches represent promising novel therapeutic options for the treatment of atrial fibrillation, because conventional medical treatment is of limited efficacy and is hampered by potentially serious ventricular side effects (proarrhythmia, negative inotropy). Cardiac targets for atrial-selective antiarrhythmic compounds include ionic currents (IKACh , IKur ) and connexins (Cx-40) as well as potentially remodeling-suppression and state-dependent sodium current (INa )-blockade. This review focuses on the theory of atrial-selective action and on atrial-selective compounds in development, summarizing mechanisms of action and available in vitro and in vivo data. It also touches on innovative gene-therapy approaches that might eventually provide new atrial-selective therapeutic options.