Atorvastatin Given prior to Electrical Cardioversion Does Not Affect the Recurrence of Atrial Fibrillation in Patients with Persistent Atrial Fibrillation Who Are on Antiarrhythmic Therapy

Abstract

Objective: In this study, our aim was to evaluate the effect of a higher dose of atorvastatin on the recurrence rate of atrial fibrillation (AF) after electrical cardioversion (EC) in addition to antiarrhythmic therapy. Subjects and Methods: 48 patients with persistent AF were included in this study. The patients were randomized to an atorvastatin 40-mg treatment group and a control group. Atorvastatin was started 3 weeks before EC and was continued for 2 months after EC. EC was performed using biphasic shocks after 3 weeks of treatment with the orally administered anticoagulant warfarin. Lipid and inflammatory parameters (high-sensitivity C-reactive protein, white blood cell count and fibrinogen level) were evaluated at the baseline and before EC. The endpoint of this study was electrocardiographically confirmed recurrence of AF of >10 min. Results: There were no significant differences in baseline characteristics and lipid and inflammatory marker levels between the treatment and control groups. Total cholesterol and low-density lipoprotein levels were significantly decreased in patients taking atorvastatin for 2 months compared with baseline values (174 ± 31 vs. 129 ± 25 mg/dl, p = 0.001, and 112 ± 23 vs. 62 ± 20 mg/dl, p = 0.001, respectively), while no significant change occurred in control patients (168 ± 26 vs. 182 ± 29 mg/dl, p = 0.07, and 99 ± 18 vs. 108 ± 26 mg/dl, p = 0.1, respectively). At the end of the 2-month follow-up period, 9 patients (20.5%) experienced AF recurrence, and there was no significant difference in AF recurrence rate between the treatment and control groups (26 vs. 13%; p = 0.2). Conclusion: Atorvastatin therapy prior to EC does not prevent the recurrence of arrhythmia in patients with persistent AF who are receiving antiarrhythmic therapy.

The preventive effect of atorvastatin on atrial fibrillation: a meta-analysis of randomized controlled trials

“…The results were similar when studies with Jadad score < 3 [16,18,21,27,30] were removed from the analysis (OR 0.49, 95% CI 0.32–0.73; P  = 0.0004). These studies were also excluded when performing the subgroup analyses and no obvious change in effect size was detected.…”

“…Ten studies [15,17-19,21-24,26,28] investigated the use of atorvastatin in primary prevention of AF in patients after cardiac surgery (n = 8) [15,17,19,21-24,28] or implantation of a pacemaker (n = 1) [18], or in patients with a prior stroke or transient ischemic attack (n = 1) [26]. Seven studies [14,16,20,25,27,29,30] investigated the use of atorvastatin in secondary prevention of AF in patients who received electrical cardioversion (EC; n = 4) [16,20,25,27], catheter ablation (n = 2) [29,30] or pharmacological treatment (n = 1) [14]. The MIRACL trial [13] included both AF and non-AF patients, so MIRACL-1 and MIRACL-2 were used to represent the primary and secondary prevention subgroups.…”

“…Intervention strategies of atorvastatin and documentation of AF were also variable. The studies received Jadad scores of 2 (n = 5) [16,18,21,27,30], 3 (n = 3) [14,19,24], 4 (n = 3) [15,23,29], or 5 (n = 7) [13,17,20,22,25,26,28] points. The characteristics of the studies included in the meta-analysis are shown in Table 1.…”

“…Eight trials [14,16,20,25,27,29,30] that investigated the use of atorvastatin in secondary prevention of AF were divided into two subgroups on the basis of whether patients underwent EC. The results of subgroup analysis showed that atorvastatin had no beneficial effect either in patients with EC (OR 0.57, 95% CI 0.25–1.32, P  = 0.19) or without EC (OR 0.38, 95% CI 0.14–1.06, P  = 0.06).…”

Effect of Atorvastatin on Serum Levels of Total Cholesterol and High-Sensitivity C-reactive Protein in High-Risk Patients with Atrial Fibrillation in Asia

“…Finally, 13 studies published between 2006 and 2014 that included 1239 patients with AF were chosen for the present meta-analysis. 13,14,[25][26][27][28][29][30][31][32][33][34][35] Among the studies, 11 were from China and the others were from Turkey. The sample sizes in these studies ranged from 22 to 104.…”