Effect of Atorvastatin on the Recurrence Rates of Atrial Fibrillation After Electrical Cardioversion

Özaydın, Mehmet; Varol, Ercan; Aslan, Şükrü; Küçüktepe, Zehra; Doğan, Abdullah; Öztürk, Mustafa; Altınbaş, Ahmet

doi:10.1016/j.amjcard.2005.11.082

Cited by 127 publications

(107 citation statements)

References 10 publications

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“…[24][25][26] In cases of AF, statins may be expected to suppress atrial remodeling, but documentation of a clinical effect is still limited to cases of postoperative AF after cardiac surgery, 27) or the recurrence rate of AF after electrical cardioversion. 28) In the present study, we have documented a signifi cant correlation between statin use and longer FCL, which may indicate a prophylactic suppression of the progression of atrial remodeling, at least in patients with new-onset AF. This may also indicate that such "upstream therapy" may be effective in cases of AF, in its extremely early phase of clinical appearance.…”

Section: Detection Of New-onset Af In Clinical Studymentioning

confidence: 76%

Prophylactic Statin Administration May Prevent Shortening of the Fibrillation Cycle Length in Patients With New-Onset Atrial Fibrillation

Oikawa

Niwano

et al. 2013

Int. Heart J.

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SummaryPatients with recently diagnosed atrial fi brillation (AF) tend to exhibit a longer fi brillation cycle length (FCL) than those having a longer clinical history. However, the electrophysiological properties of new-onset AF may vary because of the clinical background of patients. In this study, we evaluated clinical factors to identify the determinants of FCL in new-onset AF. Electrocardiograms (ECGs) recorded from 2008 through 2011 were analyzed using our digital ECG-profi ling system. In the 1,578 AF episodes recorded, 466 new-onset AF episodes were identifi ed using clinical referral history and previous ECGs. After evaluating FCL in these new-onset AF episodes, using a customized fi brillation wave analyzer with fast Fourier transform analysis, we divided the patients into a longer-FCL group and a shorter-FCL group using the median FCL (158 ms). Propensity score matching yielded 135 matched pairs of patients with comparable mean ages between the two groups. Four factors (brain natriuretic peptide levels, and use of angiotensin receptor blockers, calcium channel blockers or statins) exhibited a signifi cant difference between the two groups. Multivariate analysis revealed that statin use was the only signifi cant independent predictor of longer FCL (Odds ratio, 3.86; 95% CI, 1.65-9.63; P = 0. and it is a major cause of morbidity and mortality in the general population.2) The prevalence of AF is related to aging, and there are approximately 716,000 people with AF in Japan, an overall prevalence of 0.56% in the Japanese population.3) The arrhythmogenic substrate of AF is known to be constructed progressively under various pathological conditions, including AF itself. This process is understood as atrial remodeling. Therapies designed to suppress this remodeling are termed "upstream therapy." Although the suppressive effects of some medicines, such as angiotensin receptor blockers (ARBs) 4,5) or statins, 6,7) as upstream therapy have been experimentally documented in animal models of AF, the clinical effect of this therapy is still controversial. [8][9][10] The reason for this discrepancy between experimental and clinical results remains unclear, but the atrial structural changes may have already progressed further in clinical cases than in experimental models, even in cases with paroxysmal AF, because of the infl uence of various clinical factors. We evaluated the atrial electrophysiological properties through analysis of the fi brillation cycle length (FCL).11) This method enables us to evaluate the degree of refractory shortening or the complexity of the AF substrate noninvasively and repeatedly, and then gives us indirect but important information about the degree of atrial remodeling.12) In the present study, we hypothesized that various clinical factors including those related to the disease underlying AF and/or the use of various prescribed medicines, may infl uence atrial electrophysiological properties even before the clinical appearance of AF. These clinical factors were compared between patients...

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Section: Detection Of New-onset Af In Clinical Studymentioning

confidence: 76%

Prophylactic Statin Administration May Prevent Shortening of the Fibrillation Cycle Length in Patients With New-Onset Atrial Fibrillation

Oikawa

Niwano

et al. 2013

Int. Heart J.

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“…The benefit of statin therapy seemed more marked in the postoperative 37) and secondary prevention of AF. 9) Previous clinical studies evaluating the efficacy of atorvastatin and pravastatin on recurrence of AF have been conducted in patients with paroxysmal form, 39) persistent form lasting 48 hours or longer after electrical cardioversion, [40][41][42] and postoperative AF 43) over short follow-up periods 39,40,42,43) (Table IIIB). In contrast, few studies have examined the efficacy of statins in patients with paroxysmal 44) and persistent AF on a long-term basis (> 2 years).…”

Section: Discussionmentioning

confidence: 99%

“…42) However, atorvastatin, a lipophilic statin, was demonstrated to be effective for preventing recurrence of paroxysmal and persistent AF in a prospective randomized study. 40,46) A prospective, randomized, double-blind, placebo-controlled study initiated treatment with atorvastatin 1 week before elective cardiac surgery and showed a significant reduction in the incidence of postoperative AF. 43) In addition, Naji, et al reported that atorvastatin was superior to simvastatin for preventing recurrence of persistent AF after electrical cardioversion in their retrospective study.…”

Section: Discussionmentioning

confidence: 99%

Long-term Efficacy of Upstream Therapy With Lipophilic or Hydrophilic Statins on Antiarrhythmic Drugs in Patients With Paroxysmal Atrial Fibrillation Comparison Between Atorvastatin and Pravastatin

et al. 2011

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SummaryThere is little information available on the benefits of selection of statins as upstream therapy for the prevention of paroxysmal atrial fibrillation (AF). We compared the efficacy and safety of atorvastatin (A-group, n = 43) and pravastatin (P-group, n = 41) as upstream therapy in patients with paroxysmal AF and dyslipidemia. A total of 84 patients (45 men, mean age, 66 ± 9 years, mean follow-up, 49 ± 32 months) were retrospectively assigned to receive atorvastatin (n = 41;10 mg/day) or pravastatin (n = 43 ; 10 mg/day). Survival rates free from AF recurrence at 1, 6, 12, and 24 months were 93%, 74%, 60%, and 53% in A-group, and 88%, 49%, 37%, and 29%, respectively, in P-group (P = 0.029, Agroup versus P-group). Survival rates free from conversion to permanent AF at 12, 36, 60, and 90 months were 100%, 100%, 98%, and 95% in A-group, and 100%, 95%, 88%, and 83%, respectively, in P-group (P = 0.063, A-group versus P-group). Using a logistic regression model, atorvastatin was found to be associated with a significantly reduced risk of AF recurrence in comparison to pravastatin (unadjusted odds ratio [OR] = 0.27, 95% confidence interval 0.11-0.68, P = 0.005). This association remained significant after adjustment for potentially confounding variables (OR = 0.26, 95% CI 0.08-0.86, P = 0.027). Using a logistic regression model, atorvastatin was not associated with a significantly reduced risk of converting to permanent AF in comparison to pravastatin (unadjusted OR = 0.29, 95% CI 0.05-1.50, P = 0.138), but this association did show a significant difference after adjustment for potentially confounding variables in a multivariate model (OR = 0.08, 95% CI 0.06-0.96, P = 0.046). Adverse effects requiring discontinuation of statins were observed in 1 case (2%, myalgia) in A-group, and 1 case (2%, elevation in CPK level ≥ 500 IU/L) in P-group, respectively (P = NS, A-group versus P-group). Atorvastatin, a lipophilic statin, was considered to be more effective in preventing recurrence of paroxysmal AF and conversion to permanent AF than pravastatin, a hydrophilic statin. (Int Heart J 2011; 52: 359-365)

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“…35) In cases of persistent AF, recurrence after cardioversion could be prevented. 36,37) It has been reported sporadically that pretreatment with statins reduced the incidence of new manifestation of postoperative AF, which was associated with a shortened hospital stay. However, since the doses used in the studies in Western countries mentioned above were about 2 -3 times higher than the standard dose used in Japan, it remains unknown whether statins at the standard Japanese dose could also be effective for the prevention of progression of AF into structural remodeling as well as recurrence of AF.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Efficacy of Upstream Therapy Using Angiotensin-Converting Enzyme Inhibitors and Statins in Combination With Antiarrhythmic Agents for the Treatment of Paroxysmal Atrial Fibrillation

et al. 2009

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SummaryThe long-term efficacy of upstream therapy to prevent occurrence of paroxysmal atrial fibrillation (AF) in Japanese patients remains unclear. We retrospectively assessed the long-term efficacy of combination therapy with pravastatin (10 mg/day) and enalapril (5 mg/day) in addition to antiarrhythmic drugs (AAD) for maintaining sinus rhythm in patients with AF. This study included 319 patients (221 men, 98 women, mean age, 68 ± 10 years, mean follow-up period, 50 ± 34 months) who were divided into 4 groups: group I (n = 191) without combination therapy -namely pravastatin(-) and enalapril(-); group II (n = 81) with combination therapy -pravastatin (-) and enalapril (+) (n = 81); group III (n = 29) with combination therapy -pravastatin (+) and enalapril (-); and group IV (n = 18) with combination therapy -pravastatin (+) and enalapril (+). The percentages of patients free from conversion to permanent AF at 12, 36, 60, 90, and 120 months were as follows: group I 88, 83, 78, 75, and 73%, respectively; group II 96, 88, 79, 77, and 75%, respectively; group III 100, 97, 91, 91, and 86%, respectively; group IV 100, 100, 100, 94, and 94%, respectively. The actuarial rate free from conversion to permanent AF at 120 months was significantly higher in group IV than in group I (P < 0.05). The results suggest that in patients with paroxysmal AF, the addition of both pravastatin and enalapril to AAD was more effective for maintaining sinus rhythm in terms of an upstream therapy. (Int Heart J 2009; 50: 465-476)

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Effect of Atorvastatin on the Recurrence Rates of Atrial Fibrillation After Electrical Cardioversion

Cited by 127 publications

References 10 publications

Prophylactic Statin Administration May Prevent Shortening of the Fibrillation Cycle Length in Patients With New-Onset Atrial Fibrillation

Prophylactic Statin Administration May Prevent Shortening of the Fibrillation Cycle Length in Patients With New-Onset Atrial Fibrillation

Long-term Efficacy of Upstream Therapy With Lipophilic or Hydrophilic Statins on Antiarrhythmic Drugs in Patients With Paroxysmal Atrial Fibrillation Comparison Between Atorvastatin and Pravastatin

Long-Term Efficacy of Upstream Therapy Using Angiotensin-Converting Enzyme Inhibitors and Statins in Combination With Antiarrhythmic Agents for the Treatment of Paroxysmal Atrial Fibrillation

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