Effectiveness of aldosterone antagonists for preventing atrial fibrillation after cardiac surgery in patients with systolic heart failure: a retrospective study

Abstract

Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery. There exist consistent experimental and clinical data suggesting that aldosterone antagonists (AAs) may exert beneficial effects regarding electrical and structural remodeling in failing myocardium. Recently, eplerenone (EPL) has been found to reduce the incidence of nonsurgical AF when added to guideline-recommended therapy in patients with systolic heart failure. Based on these findings, we primarily aimed to evaluate by retrospective analysis the impact of the two AAs, EPL and spironolactone (SPL), given at standard therapeutic doses in preventing new-onset POAF in patients the majority of which had a preoperative ejection fraction (EF) below 40%. A total of 332 patients (298 men/34 women, mean age 64.3 ± 9 years) without history of AF were included in this analysis; 132 of these patients received long-term EPL or SPL in addition to beta-blockade/statins therapy and 200 patients received neither EPL nor SPL. All patients underwent on-pump coronary artery bypass graft (80%) and/or valvular surgery (20%). In the nonAA group (EF = 35.8 ± 6%) 90/200 patients (45%) had POAF, while in the AA group (EF = 36.2 ± 5%) only 40/132 patients (30.3%) developed POAF (P < 0.01, χ (2) test). Multivariate logistic regression analysis revealed that only AAs and left atrial diameter significantly affected the development of POAF even when adjusted for other clinical variables (P < 0.05). In conclusion, AAs significantly reduced the incidence of POAF when added to standard heart failure therapy in patients undergoing on-pump cardiac surgery.

Spironolactone is associated with reduced risk of new-onset atrial fibrillation in patients receiving renal replacement therapy

“…Eplerenone has also been reported to reduce the incidence of new-onset AF in a subanalysis of the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF) trial [25]. The most recent study showed that aldosterone antagonists, both eplerenone and spironolactone, exert beneficial effects for preventing AF after cardiac surgery in patients with systolic heart failure [26]. The incidence and prevalence of AF in ESRD patients are higher than that in general population and are associated with increased risks of stroke and mortality.…”

Six‐Year Clinical Outcomes After Catheter Ablation of Atrial Fibrillation in Patients With Impaired Left Ventricular Function

“…Patients with reduced LVEF are at increased risk of developing AF . Therefore, long‐term outcomes after successful catheter ablation of AF may be worse in this patient population .…”

“…[6][7][8] Patients with reduced LVEF are at increased risk of developing AF. 9 Therefore, long-term outcomes after successful catheter ablation of AF may be worse in this patient population. 10 Long-term results after catheter ablation of AF in patients with reduced systolic LVEF are sparse.…”

Third-generation Mineralocorticoid Receptor Antagonists

“…The doses used were below those required to lower blood pressure or have a diuretic effect. As predicted from animal studies, some done more than 50 years earlier 60, 97 , spironolactone and eplerenone were shown to decrease cardiac arrhythmias in patients through direct effects on cardiomyocyte excitation, as well as by decreasing sympathetic nervous system activation and normalizing hypokalemia and hypomagnesaemia, including in those with coronary artery disease and chronic kidney disease without heart failure 96, 98–103 .…”