EHJ: Statins could help to prevent atrial fibrillation recurrence

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Statin therapy significantly suppressed atrial tachycardia/atrial fibrillation (AT/AF), which recurs frequently following pacemaker implantation in patients with sinus node disease, according to an observational, cohort study in the August issue of the European Heart Journal.

Data suggest that atrial pacing, statins, angiotensin-converting enzyme-inhibitors and angiotensin receptor blocking drugs prevent AT/AF in some patients, according to the researchers.

Anne M. Gillis, MD, and colleagues from the Libin Cardiovascular Institute of Alberta and department of cardiac sciences at University of Calgary in Canada, examined the clinical predictors of AT/AF recurrence in 185 consecutive patients with paroxysmal AF following dual-chamber pacemaker insertion.

Researchers evaluated predictors of AT/AF recurrence—the time to first AT/AF recurrence and AT/AF burden (h/day) was retrieved at each follow-up visit by interrogating the pacemaker.

They found that AT/AF recurred following pacemaker implantation in 157 (85 percent) patients. At one year of follow-up, patients without recurrence were more likely to be on statin therapy (54 percent) when compared with patients without statin therapy (25 percent).

Statin therapy was the only significant predictor of AT/AF recurrence in a multivariate logistic regression model, according to the investigators.

Gillis and colleagues found that AT/AF burden was significantly lower in the group on statin therapy (median 0.10 h/day) when compared with the group not on statin therapy (median 0.39 h/day).

The authors also noted that progression to permanent AF remains low over time.

In an accompanying editorial, Carsten Israel from the Goethe University Hospital in Frankfurt, Germany, noted that the therapeutic potential to suppress AF is currently under evaluation for several non-antiarrhythmic drugs, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, aldosterone receptor antagonists, anti-inflammatory and antioxidative drugs, polyunsaturated fatty acids, and HMG-CoA reductase inhibitors, i.e. statins.

He said that the “results are particularly valuable because a continuously active AF monitor in the form of a pacemaker with a highly reliable AF detection algorithm was used.” He explained that conventional diagnostic monitoring fails to detect about 70 percent of AF recurrences.

However, Israel stressed that statins failed to prevent 63 percent of AF recurrences in the current study cohort, which had established paroxysmal or persistent AF. Therefore, the study "raises the question of whether the use of statins at an earlier stage (e.g., before documentation of the first AF episode) may be valuable in preventing AF, which would best be addressed, again, using implantable devices as monitors," he concluded.