Abstract
Atrial fibrillation (AF) is the most common type of arrhythmia: a disorganized electrical atrial activity leading to irregular ventricular beats. Its most common risk factors include high blood pressure, congenital and valvular heart diseases, aging, heart failure and coronary heart diseases. Other risk factors include excessive alcohol intake, tobacco smoking, diabetes mellitus and thyrotoxicosis. However, many cases are not associated with any of these risk factors: probably, in these patients, immunological, functional and even dietary mechanisms may be responsible to induce cardiac arrhythmias. Several studies have focused on immunological and neurohumoral mechanisms; however, little information is available about the potential relationship between dietary patterns and atrial fibrillation episodes. This case report describes a potential correlation between biogenic amines in ingested food and recurrent atrial fibrillation onset in a 61-years old man in absence of a remarkable clinical history and of the most common risk factors. The nutritional team instituted a food protocol: a low calories diet and eliminating biogenic amines-rich foods. During the follow-up (16 months), there was a noticeable weight loss and no arrhythmic episodes happened again. This clinical case provides evidence for a possible new relationship between some kinds of food and heart conduction (defining the very novel field of arrhythmogenic foods and of “nutri-arrhythmias”), recognizing biogenic amines-rich foods abuse as the potential trigger and substrate for atrial fibrillation. Therefore, we suggested that clinical history in patients with new onset AF should also include questions concerning the ingestion of histamine-rich foodstuffs (or other amines-rich food) and alcohol consumption: their effects may result to be synergistic in the alteration of cardiac rhythm and may explain the recurrence of an unexplained atrial fibrillation.
Highlights
Heart arrhythmias are a common group of clinical conditions with an abnormal activation of myocardium and a perturbed rhythm of heartbeat
Detoxifying oxidation is carried out by specific amine oxidases. These enzymes are usually classified as monoamine oxidases (MAO) and diamine oxidases (DAO), depending on the number of amino groups preferentially oxidized
An accurate assessment of cardiac arrhythmias always makes the investigation for underlying causes necessary
Summary
Heart arrhythmias are a common group of clinical conditions with an abnormal activation of myocardium and a perturbed rhythm of heartbeat. A large number of AF occurs in absence of known structural anomalies or cardiovascular diseases and no pathological cardiac findings can be documented [3]. Endogenous BA can be present in both fermented and non-fermented food; a high BA concentration is observed in food with high protein content, in particular fermented and ripened food [10] This is attributable to the higher microbial decarboxylases activity in bacteria, representing the contaminating microflora or intentionally added [11]. Detoxifying oxidation is carried out by specific amine oxidases These enzymes are usually classified as monoamine oxidases (MAO) and diamine oxidases (DAO), depending on the number of amino groups preferentially oxidized. These oxidases are present in the mitochondria of animal tissues, mainly in liver, kidney, pancreas, intestine, brain and blood [19]
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