Fig. 4

Candidates to formulate individualized measures for atrial fibrillation (AF) patients targeting microbes. The dysbiosis and symbiotic state of gut microbiota interact with the progression of diseases. The mechanistic link between the gut microbiome and AF poses these interactions as promising therapeutic targets. There are diverse interventions that can be implemented to prevent the deleterious biological effects of ecological dysbiosis, mainly including dietary interventions, probiotic/prebiotic supplementation, drugs, and fecal microbiota transplantation (FMT). Mediterranean diet and high-fiber diet can reduce circulating lipopolysaccharides (LPS) and trimethylamine oxide (TMAO) levels, alleviating oxidative stress and thus slowing AF development. The utilization of well-defined microbial components (probiotics) and non-microbial substances (prebiotics) that may modify the structure of the microbial community has revealed promising results in AF treatment. Moreover, nonabsorbable inhibitors, antibiotics, statins, and oral anticoagulants may exert effects on arrhythmic substrates through gut microbiota. 3,3-dimethyl-1-butanol (DMB), a prototype of lyase inhibitor, can alleviate AF progression by diminishing trimethylamine (TMA)/TMAO synthesis. FMT from healthy donors can alter the patients’ gut flora to treat the disease, but the therapeutic effect of FMT on AF remains to be further explored