Exploring the effect of gut flora on atrial fibrillation based on epidemiological history

Emerging evidence from preclinical and observational studies indicates an association between gut flora dysbiosis and atrial fibrillation (AF). The gut flora constitutes a highly complex and dynamic community capable of producing diverse metabolites that influence host pathophysiology. External factors, such as diet and medications, further modulate its composition. This review synthesizes current knowledge on the relationship between gut flora and AF, emphasizing the role of microbial-derived metabolites in the underlying mechanisms of AF. We also explore the involvement of gut flora in AF-related conditions, including hypertension and diabetes. Additionally, we evaluate potential interventional strategies targeting the gut flora through dietary or pharmacological approaches for their antiarrhythmic effects. Finally, we address limitations in the current evidence and propose future research directions to clarify the causal relationship and therapeutic potential of targeting the gut flora in AF. While this review synthesizes the current evidence linking gut flora to AF, we also critically examine the limitations of the existing literature, including reliance on preclinical models, confounding factors in human studies, and inconsistencies in interventional outcomes, to provide a balanced perspective on the field's current state and future directions.