Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

Angiotensin II and angiotensin 1-7: which is their role in atrial fibrillation?

Mascolo, A; Urbanek, K; De Angelis, A; Sessa, M; Scavone, C; Berrino, L; Rosano, GMC; Capuano, A; Rossi, F (2020) Angiotensin II and angiotensin 1-7: which is their role in atrial fibrillation? Heart Fail Rev, 25 (2). pp. 367-380. ISSN 1573-7322
SGUL Authors: Rosano, Giuseppe Massimo Claudio

[img] Microsoft Word (.docx) Accepted Version
Restricted to Repository staff only until 2 August 2020.
Available under License ["licenses_description_publisher" not defined].

Download (99kB)


Atrial fibrillation (AF) is a significant cause of morbidity and mortality as well as a public health burden considering the high costs of AF-related hospitalizations. Pre-clinical and clinical evidence showed a potential role of the renin angiotensin system (RAS) in the etiopathogenesis of AF. Among RAS mediators, angiotensin II (AII) and angiotensin 1-7 (A1-7) have been mostly investigated in AF. Specifically, the stimulation of the pathway mediated by AII or the inhibition of the pathway mediated by A1-7 may participate in inducing and sustaining AF. In this review, we summarize the evidence showing that both RAS pathways may balance the onset of AF through different biological mechanisms involving inflammation, epicardial adipose tissue (EAT) accumulation, and electrical cardiac remodeling. EAT is a predictor for AF as it may induce its onset through direct (infiltration of epicardial adipocytes into the underlying atrial myocardium) and indirect (release of inflammatory adipokines, the stimulation of oxidative stress, macrophage phenotype switching, and AF triggers) mechanisms. Classic RAS blockers such as angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) may prevent AF by affecting the accumulation of the EAT, representing a useful therapeutic strategy for preventing AF especially in patients with heart failure and known left ventricular dysfunction. Further studies are necessary to prove this benefit in patients with other cardiovascular diseases. Finally, the possibility of using the A1-7 or ACE2 analogues, to enlarge current therapeutic options for AF, may represent an important field of research.

Item Type: Article
Additional Information: This is a post-peer-review, pre-copyedit version of an article published in Heart Failure Reviews. The final authenticated version is available online at:
Keywords: Angiotensin, Atrial fibrillation, Epicardial adipose tissue, Renin angiotensin system inhibitors, 1102 Cardiovascular Medicine And Haematology, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Heart Fail Rev
ISSN: 1573-7322
Language: eng
March 2020Published
2 August 2019Published Online
Publisher License: Publisher's own licence
PubMed ID: 31375968
Go to PubMed abstract
Publisher's version:

Actions (login required)

Edit Item Edit Item