Pro- and Anti-Arrhythmic Effects of Anti-Inflammatory Drugs

Mathieu      Granier; Francois      Massin; Jean-Luc      Pasquie

Abstract

Inflammatory process is strongly associated with cardiac arrhythmia, either as a cause or a consequence. Antiinflammatory drugs are widely prescribed, and some of them have been associated with an increased cardiovascular risk. Then, the eventual pro- or anti-arrhythmic effect of these drugs is of high interest for clinical practice. This review summarizes pro- and anti-arrhythmic effects of anti-inflammatory drugs, based on the analysis of published clinical trials. Cardiac arrhythmias are divided into atrial fibrillation (AF) and ventricular arrhythmias. Based on the literature and on pathophysiology, post-operative AF and post-ablative AF are analyzed separately. After a brief overview of fundamental mechanisms of arrhythmia and their relationship to inflammation, we thought to examine corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), and colchicine effects on cardiac arrhythmias. All anti-inflammatory drugs have demonstrated anti-arrhythmic properties in post operative AF. Apart from this specific condition, NSAIDs and corticosteroids increase the risk of AF. Regarding ventricular arrhythmias the effects of these drugs are not well established and would require further investigations.

Keywords: Anti-inflammatory, atrial fibrillation, supra-ventricular arrhythmias, ventricular tachycardia, ventricular arrhythmia, corticosteroid, NSAID, colchicine, AF ablation