Gut microbiome and atrial fibrillation: mechanistic insights metabolites and comorbidities. Systematic review

Nov 3, 2025Gut microbes

Gut bacteria, their byproducts, and related health conditions linked to irregular heartbeat

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Abstract

The composition in patients with (AF) shows significant alterations compared to healthy individuals.

  • The gut microbiome in AF patients features increased levels of certain bacterial genera and decreased levels of others.
  • Distinct microbial changes in AF are also observed in related conditions such as heart failure, hypertension, diabetes, and coronary artery disease.
  • Gut-derived metabolites like and choline are associated with new-onset and postoperative AF, potentially influencing disease mechanisms.
  • Short-chain fatty acids, which are reduced in AF patients, may have protective effects against the condition.
  • Elevated levels of lipopolysaccharides correlate with AF onset and recurrence, likely due to inflammatory processes.
  • Other metabolites, such as indoxyl sulfate and bile acids, may promote arrhythmias through mechanisms involving oxidative stress and disrupted calcium signaling.

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Key numbers

10–16%
Increased risk per level
Risk increase based on findings from a large prospective study.
2.88
Odds of postoperative with elevated
Odds ratio from a smaller study involving 100 patients.
3.67
recurrence risk associated with indoxyl sulfate
Adjusted hazard ratio from a prospective cohort study of 105 patients.

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