PDF(Pubmed)
Abstract：
Atrial fibrillation (AF) is a common cardiac arrhythmia with a significant impact on patient outcomes and healthcare systems. Given the rising incidence of AF with age and its association with conditions, such as diabetes, there is growing interest in exploring pharmacological interventions that might mitigate AF risk. Metformin, a widely prescribed antihyperglycemic agent for type 2 diabetes mellitus (T2DM), has demonstrated various cardiovascular benefits, including anti-inflammatory and antioxidative properties, leading to speculations about its potential role in AF prevention. This systematic review synthesizes findings from five studies examining the association between metformin use and AF risk in patients with T2DM. The review included a dynamic cohort study, three retrospective cohort studies, and a case report, all sourced from databases, such as PubMed, Embase, and the Cochrane Library. The results are mixed; while some studies suggest that metformin use is linked to a reduced incidence of AF, others report no significant association, particularly in postoperative settings. The largest cohort study highlighted a dose-response relationship, suggesting prolonged metformin use correlates with lower AF risk. Conversely, a case report raised concerns about metformin-induced lactic acidosis potentially triggering AF episodes. The review underscores the heterogeneity in study designs and outcomes, pointing to the need for more robust research to establish causality and clarify underlying mechanisms. Future studies should prioritize prospective designs and explore the pleiotropic effects of metformin on atrial remodeling and electrophysiology to better understand its potential role in AF prevention.
摘要：
心房颤动（AF）是一种常见的心律失常，对患者预后和医疗保健系统有重大影响。考虑到房颤的发病率随着年龄的增长而上升,以及房颤与疾病的关系,比如糖尿病，越来越多的人对探索可能减轻房颤风险的药物干预措施感兴趣.二甲双胍,一种广泛用于2型糖尿病（T2DM）的抗高血糖药，已经证明了各种心血管益处，包括抗炎和抗氧化特性，导致人们猜测其在房颤预防中的潜在作用。本系统综述综合了五项研究的结果，这些研究检查了二甲双胍使用与T2DM患者AF风险之间的关系。该综述包括一项动态队列研究，三项回顾性队列研究，和一个病例报告,全部来自数据库，比如PubMed,Embase,还有Cochrane图书馆.结果喜忧参半；虽然一些研究表明二甲双胍的使用与降低房颤的发生率有关，其他人报告没有重大关联，特别是在术后设置。最大的队列研究强调了剂量反应关系，提示长期使用二甲双胍与房颤风险降低相关.相反，一例病例报告引发了对二甲双胍诱导的乳酸性酸中毒可能引发AF发作的担忧.这篇综述强调了研究设计和结果的异质性，指出需要更有力的研究来建立因果关系并阐明潜在的机制。未来的研究应优先考虑前瞻性设计，并探索二甲双胍对心房重构和电生理的多效性作用，以更好地了解其在房颤预防中的潜在作用。
