Research progress on the relationship between hypothyroidism and atrial fibrillation_West China Medical Journal

Authors：

HUA Cuncun , MU Yameng ,  ZHONG Guangzhen

Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P. R. China;

Corresponding author：

ZHONG Guangzhen, Email: zhongguangzhen@hotmail.com

Keywords：

Thyroid function; Hypothyroidism; Atrial fibrillation

DOI：

10.7507/1002-0179.202008258

Video：

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Atrial fibrillation is one of the most common arrhythmias, which can cause embolism, heart failure, cardiac arrest, and other cardiovascular deaths, causing a serious economic burden on patients. Scholars have begun to explore the relationship between atrial fibrillation and hypothyroidism, including clinical hypothyroidism, subclinical hypothyroidism, and threshold state of thyroid function, which means that thyroid stimulating hormone, free triiodothyronine, and free thyroxine are high or low in the normal range. This article reviews the occurrence and mechanism of hypothyroidism promoting atrial fibrillation, and aims to provide a basis for clinical intervention in patients with hypothyroidism to reduce the occurrence of atrial fibrillation.

Citation： HUA Cuncun, MU Yameng, ZHONG Guangzhen. Research progress on the relationship between hypothyroidism and atrial fibrillation. West China Medical Journal, 2021, 36(9): 1293-1296. doi: 10.7507/1002-0179.202008258 Copy

1.	Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int J Stroke, 2021, 16(2): 217-221.
2.	Zoni-Berisso M, Lercari F, Carazza T, et al. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol, 2014, 6: 213-220.
3.	Passman R. Atrial fibrillation and stroke: the more we learn, the less we understand. Am Heart J, 2018, 201: 158-159.
4.	Saksena S, Slee A. Atrial fibrillation and its pernicious role in heart failure with preserved ejection fraction: a new frontier in interventional electrophysiology. J Interv Card Electrophysiol, 2018, 51(2): 89-90.
5.	Ruddox V, Sandven I, Munkhaugen J, et al. Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: a systematic review and meta-analysis. Eur J Prev Cardiol, 2017, 24(14): 1555-1566.
6.	黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗的建议-2018. 中国心脏起搏与心电生理杂志, 2018, 32(4): 315-368.
7.	Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet, 2015, 386(9989): 154-162.
8.	Wang L, Zhang Y. Role of hyperhomocysteine, thyroid dysfunction and their interaction in ischemic stroke patients with non-valvular atrial fibrillation. Sci Rep, 2020, 10(1): 12419.
9.	Reddy V, Taha W, Kundumadam S, et al. Atrial fibrillation and hyperthyroidism: a literature review. Indian Heart J, 2017, 69(4): 545-550.
10.	Ellervik C, Roselli C, Christophersen IE, et al. Assessment of the relationship between genetic determinants of thyroid function and atrial fibrillation: a mendelian randomization study. JAMA Cardiol, 2019, 4(2): 144-152.
11.	中华医学会内分泌学分会. 成人甲状腺功能减退症诊治指南. 中华内分泌代谢杂志, 2017, 33(2): 167-180.
12.	Zhang Y, Dedkov EI, Teplitsky D, et al. Both hypothyroidism and hyperthyroidism increase atrial fibrillation inducibility in rats. Circ Arrhythm Electrophysiol, 2013, 6(5): 952-959.
13.	Li J, Liu Z, Zhao H, et al. Alterations in atrial ion channels and tissue structure promote atrial fibrillation in hypothyroid rats. Endocrine, 2019, 65(2): 338-347.
14.	Guerra F, Brambatti M, Nieuwlaat R, et al. Symptomatic atrial fibrillation and risk of cardiovascular events: data from the Euro Heart Survey. Europace, 2017, 19(12): 1922-1929.
15.	Jaimes MC, Torrado LAA, Reyes NFS, et al. Hypothyroidism is a risk factor for atrial fibrillation after coronary artery bypass graft. Braz J Cardiovasc Surg, 2017, 32(6): 475-480.
16.	Morishima I, Okumura K, Morita Y, et al. High-normal thyroid-stimulating hormone shows a potential causal association with arrhythmia recurrence after catheter ablation of atrial fibrillation. J Am Heart Assoc, 2018, 7(14): e009158.
17.	Liu LM, Shen LS, Liu SY, et al. Correlations between low thyroid function and incidence of atrial fibrillation in hypertrophic obstructive cardiomyopathy. Chronic Dis Transl Med, 2020, 6(1): 35-45.
18.	Kim EJ, Lyass A, Wang N, et al. Relation of hypothyroidism and incident atrial fibrillation (from the Framingham Heart Study). Am Heart J, 2014, 167(1): 123-126.
19.	Selmer C, Olesen JB, Hansen ML, et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. BMJ, 2012, 345: e7895.
20.	Moon S, Kim MJ, Yu JM, et al. Subclinical hypothyroidism and the risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies. Thyroid, 2018, 28(9): 1101-1110.
21.	Sawin CT. Subclinical hypothyroidism in older persons. Clin Geriatr Med, 1995, 11(2): 231-238.
22.	Sairaku A, Nakano Y, Uchimura Y, et al. Increased left atrial pressure in non-heart failure patients with subclinical hypothyroidism and atrial fibrillation. Endocr Connect, 2016, 5(3): 101-106.
23.	Kong SH, Yoon JW, Kim SY, et al. Subclinical hypothyroidism and coronary revascularization after coronary artery bypass grafting. Am J Cardiol, 2018, 122(11): 1862-1870.
24.	Martínez-Comendador J, Marcos-Vidal JM, Gualis J, et al. Subclinical hypothyroidism might increase the risk of postoperative atrial fibrillation after aortic valve replacement. Thorac Cardiovasc Surg, 2016, 64(5): 427-433.
25.	王小瑞, 赵菊珍, 郭琦, 等. 亚临床甲状腺功能减退患者快速心律失常的治疗观察. 中国医学工程, 2013, 21(12): 126-127.
26.	Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA guideline: management of subclinical hypothyroidism. Eur Thyroid J, 2013, 2(4): 215-228.
27.	Baumgartner C, da Costa BR, Collet TH, et al. Thyroid function within the normal range, subclinical hypothyroidism, and the risk of atrial fibrillation. Circulation, 2017, 136(22): 2100-2116.
28.	Wei SB, Wang W, Liu N, et al. U-shaped association between serum free triiodothyronine and recurrence of atrial fibrillation after catheter ablation. J Interv Card Electrophysiol, 2018, 51(3): 263-270.
29.	Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol, 2008, 51(8): 802-809.
30.	Liu L, Yun F, Zhao H, et al. Atrial sympathetic remodeling in experimental hyperthyroidism and hypothyroidism rats. IntJ Cardiol, 2015, 187: 148-150.
31.	Chen WJ, Lin KH, Lee YS. Molecular characterization of myocardial fibrosis during hypothyroidism: evidence for negative regulation of the pro-alpha1(I) collagen gene expression by thyroid hormone receptor. Mol Cell Endocrinol, 2000, 162(1/2): 45-55.
32.	Nattel S, Harada M. Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. J Am Coll Cardiol, 2014, 63(22): 2335-2345.
33.	Packer M. Characterization, pathogenesis, and clinical implications of inflammation-related atrial myopathy as an important cause of atrial fibrillation. J Am Heart Assoc, 2020, 9(7): e015343.
34.	Tayde PS, Bhagwat NM, Sharma P, et al. Hypothyroidism and depression: are cytokines the link?. Indian J Endocrinol Metab, 2017, 21(6): 886-892.
35.	Carlisle MA, Fudim M, DeVore AD, et al. Heart failure and atrial fibrillation, like fire and fury. JACC Heart Fail, 2019, 7(6): 447-456.
36.	Gerdes AM, Iervasi G. Thyroid replacement therapy and heart failure. Circulation, 2010, 122(4): 385-393.
37.	Wändell P, Carlsson AC, Sundquist J, et al. Effect of levothyroxine treatment on incident dementia in adults with atrial fibrillation and hypothyroidism. Clin Drug Investig, 2019, 39(2): 187-195.
38.	Wändell P, Carlsson AC, Holzmann MJ, et al. Comparison of mortality and nonfatal cardiovascular events in adults with atrial fibrillation with versus without levothyroxine treatment. Am J Cardiol, 2017, 120(11): 1974-1979.
39.	Chow B, French A. Conversion of atrial fibrillation after levothyroxine in a dog with hypothyroidism and arterial thromboembolism. J Small Anim Pract, 2014, 55(5): 278-282.
40.	张帆, 洪丽荣. 胺碘酮相关甲状腺功能障碍的诊治. 中国实用内科杂志, 2019, 39(4): 336-341, 346.
41.	Huang JH, Lin YK, Hsieh MH, et al. Thyroxine monotherapy without amiodarone enhances atrial fibrillation recurrences in amiodarone-induced hypothyroidism. Int J Cardiol, 2011, 152(2): 277-278.
42.	Vargas-Uricoechea H, Bonelo-Perdomo A, Sierra-Torres CH. Effects of thyroid hormones on the heart. Clin Investig Arterioscler, 2014, 26(6): 296-309.
43.	Klein I, Danzi S. Thyroid disease and the heart. Curr Probl Cardiol, 2016, 41(2): 65-92.
44.	牛升梅, 石慧丽, 钟光珍, 等. 亚临床甲状腺功能减退与甲状腺功能减退患者心脏结构及功能的改变. 安徽医学, 2018, 39(12): 1423-1426.

1. Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int J Stroke, 2021, 16(2): 217-221.
2. Zoni-Berisso M, Lercari F, Carazza T, et al. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol, 2014, 6: 213-220.
3. Passman R. Atrial fibrillation and stroke: the more we learn, the less we understand. Am Heart J, 2018, 201: 158-159.
4. Saksena S, Slee A. Atrial fibrillation and its pernicious role in heart failure with preserved ejection fraction: a new frontier in interventional electrophysiology. J Interv Card Electrophysiol, 2018, 51(2): 89-90.
5. Ruddox V, Sandven I, Munkhaugen J, et al. Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: a systematic review and meta-analysis. Eur J Prev Cardiol, 2017, 24(14): 1555-1566.
6. 黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗的建议-2018. 中国心脏起搏与心电生理杂志, 2018, 32(4): 315-368.
7. Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet, 2015, 386(9989): 154-162.
8. Wang L, Zhang Y. Role of hyperhomocysteine, thyroid dysfunction and their interaction in ischemic stroke patients with non-valvular atrial fibrillation. Sci Rep, 2020, 10(1): 12419.
9. Reddy V, Taha W, Kundumadam S, et al. Atrial fibrillation and hyperthyroidism: a literature review. Indian Heart J, 2017, 69(4): 545-550.
10. Ellervik C, Roselli C, Christophersen IE, et al. Assessment of the relationship between genetic determinants of thyroid function and atrial fibrillation: a mendelian randomization study. JAMA Cardiol, 2019, 4(2): 144-152.
11. 中华医学会内分泌学分会. 成人甲状腺功能减退症诊治指南. 中华内分泌代谢杂志, 2017, 33(2): 167-180.
12. Zhang Y, Dedkov EI, Teplitsky D, et al. Both hypothyroidism and hyperthyroidism increase atrial fibrillation inducibility in rats. Circ Arrhythm Electrophysiol, 2013, 6(5): 952-959.
13. Li J, Liu Z, Zhao H, et al. Alterations in atrial ion channels and tissue structure promote atrial fibrillation in hypothyroid rats. Endocrine, 2019, 65(2): 338-347.
14. Guerra F, Brambatti M, Nieuwlaat R, et al. Symptomatic atrial fibrillation and risk of cardiovascular events: data from the Euro Heart Survey. Europace, 2017, 19(12): 1922-1929.
15. Jaimes MC, Torrado LAA, Reyes NFS, et al. Hypothyroidism is a risk factor for atrial fibrillation after coronary artery bypass graft. Braz J Cardiovasc Surg, 2017, 32(6): 475-480.
16. Morishima I, Okumura K, Morita Y, et al. High-normal thyroid-stimulating hormone shows a potential causal association with arrhythmia recurrence after catheter ablation of atrial fibrillation. J Am Heart Assoc, 2018, 7(14): e009158.
17. Liu LM, Shen LS, Liu SY, et al. Correlations between low thyroid function and incidence of atrial fibrillation in hypertrophic obstructive cardiomyopathy. Chronic Dis Transl Med, 2020, 6(1): 35-45.
18. Kim EJ, Lyass A, Wang N, et al. Relation of hypothyroidism and incident atrial fibrillation (from the Framingham Heart Study). Am Heart J, 2014, 167(1): 123-126.
19. Selmer C, Olesen JB, Hansen ML, et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. BMJ, 2012, 345: e7895.
20. Moon S, Kim MJ, Yu JM, et al. Subclinical hypothyroidism and the risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies. Thyroid, 2018, 28(9): 1101-1110.
21. Sawin CT. Subclinical hypothyroidism in older persons. Clin Geriatr Med, 1995, 11(2): 231-238.
22. Sairaku A, Nakano Y, Uchimura Y, et al. Increased left atrial pressure in non-heart failure patients with subclinical hypothyroidism and atrial fibrillation. Endocr Connect, 2016, 5(3): 101-106.
23. Kong SH, Yoon JW, Kim SY, et al. Subclinical hypothyroidism and coronary revascularization after coronary artery bypass grafting. Am J Cardiol, 2018, 122(11): 1862-1870.
24. Martínez-Comendador J, Marcos-Vidal JM, Gualis J, et al. Subclinical hypothyroidism might increase the risk of postoperative atrial fibrillation after aortic valve replacement. Thorac Cardiovasc Surg, 2016, 64(5): 427-433.
25. 王小瑞, 赵菊珍, 郭琦, 等. 亚临床甲状腺功能减退患者快速心律失常的治疗观察. 中国医学工程, 2013, 21(12): 126-127.
26. Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA guideline: management of subclinical hypothyroidism. Eur Thyroid J, 2013, 2(4): 215-228.
27. Baumgartner C, da Costa BR, Collet TH, et al. Thyroid function within the normal range, subclinical hypothyroidism, and the risk of atrial fibrillation. Circulation, 2017, 136(22): 2100-2116.
28. Wei SB, Wang W, Liu N, et al. U-shaped association between serum free triiodothyronine and recurrence of atrial fibrillation after catheter ablation. J Interv Card Electrophysiol, 2018, 51(3): 263-270.
29. Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol, 2008, 51(8): 802-809.
30. Liu L, Yun F, Zhao H, et al. Atrial sympathetic remodeling in experimental hyperthyroidism and hypothyroidism rats. IntJ Cardiol, 2015, 187: 148-150.
31. Chen WJ, Lin KH, Lee YS. Molecular characterization of myocardial fibrosis during hypothyroidism: evidence for negative regulation of the pro-alpha1(I) collagen gene expression by thyroid hormone receptor. Mol Cell Endocrinol, 2000, 162(1/2): 45-55.
32. Nattel S, Harada M. Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. J Am Coll Cardiol, 2014, 63(22): 2335-2345.
33. Packer M. Characterization, pathogenesis, and clinical implications of inflammation-related atrial myopathy as an important cause of atrial fibrillation. J Am Heart Assoc, 2020, 9(7): e015343.
34. Tayde PS, Bhagwat NM, Sharma P, et al. Hypothyroidism and depression: are cytokines the link?. Indian J Endocrinol Metab, 2017, 21(6): 886-892.
35. Carlisle MA, Fudim M, DeVore AD, et al. Heart failure and atrial fibrillation, like fire and fury. JACC Heart Fail, 2019, 7(6): 447-456.
36. Gerdes AM, Iervasi G. Thyroid replacement therapy and heart failure. Circulation, 2010, 122(4): 385-393.
37. Wändell P, Carlsson AC, Sundquist J, et al. Effect of levothyroxine treatment on incident dementia in adults with atrial fibrillation and hypothyroidism. Clin Drug Investig, 2019, 39(2): 187-195.
38. Wändell P, Carlsson AC, Holzmann MJ, et al. Comparison of mortality and nonfatal cardiovascular events in adults with atrial fibrillation with versus without levothyroxine treatment. Am J Cardiol, 2017, 120(11): 1974-1979.
39. Chow B, French A. Conversion of atrial fibrillation after levothyroxine in a dog with hypothyroidism and arterial thromboembolism. J Small Anim Pract, 2014, 55(5): 278-282.
40. 张帆, 洪丽荣. 胺碘酮相关甲状腺功能障碍的诊治. 中国实用内科杂志, 2019, 39(4): 336-341, 346.
41. Huang JH, Lin YK, Hsieh MH, et al. Thyroxine monotherapy without amiodarone enhances atrial fibrillation recurrences in amiodarone-induced hypothyroidism. Int J Cardiol, 2011, 152(2): 277-278.
42. Vargas-Uricoechea H, Bonelo-Perdomo A, Sierra-Torres CH. Effects of thyroid hormones on the heart. Clin Investig Arterioscler, 2014, 26(6): 296-309.
43. Klein I, Danzi S. Thyroid disease and the heart. Curr Probl Cardiol, 2016, 41(2): 65-92.
44. 牛升梅, 石慧丽, 钟光珍, 等. 亚临床甲状腺功能减退与甲状腺功能减退患者心脏结构及功能的改变. 安徽医学, 2018, 39(12): 1423-1426.

West China Medical Journal

Research progress on the relationship between hypothyroidism and atrial fibrillation

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