The practice of repurposing drugs intended to treat one nosology as a means to treat new diseases or conditions is currently being considered. Thus, metformin, as a biguanide derivative (dimethylbiguanide), intended as a hypoglycemic agent for the treatment of patients with type 2 diabetes mellitus, shows effectiveness in the prevention and treatment of AF. A lot of data have accumulated indicating various effects of metformin, in addition to the hypoglycemic effect, in particular cardioprotective effects. Cardioprotection is based on the activation of 5’-adenosine monophosphate-activated protein kinase (AMPK), which helps maintain/generate ATP, prevent necrosis/apoptosis, reduce oxidative stress and inflammation. Experimental studies have shown that metformin prevents unfavorable structural and electrical remodeling of the atria, preventing the development of AF. Several cohort studies have been conducted in which patients treated with metformin showed a reduced risk of developing episodes of AF and increased survival, and when compared with other hypoglycemic drugs (sulfonylurea derivatives, thiazolidinedione, α-glucosidase inhibitors, dipeptidyl peptidase inhibitors, glucagon-like peptide-1 receptor agonists) it was in the metformin group that a significantly lower risk of developing AF was observed. The results of transcriptomic analysis for metformin provided data demonstrating the drug as a candidate for repurposing the drug for the treatment of AF. At this stage, further studies of appropriate quality to clarify the beneficial effects of metformin on cardiac arrhythmias are of paramount importance.

Keywords: atrial remodeling, transcriptomics, metformin, atrial fibrillation