The effect of statins on the recurrence rate of atrial fibrillation after catheter ablation: A meta‐analysis

Hong, Peng; Yang, Yuan; Zhao, Yue

doi:10.1111/pace.13485

Cited by 17 publications

(13 citation statements)

References 28 publications

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“…Rosuvastatin significantly reduced risk of incident AF, compared with placebo, in a large (17,000 patients) exploratory analysis of the JUPITER trial, 123 and statin therapy was associated with lower recurrence of AF and burden following dual-chamber pacemaker implantation in 185 patients with paroxysmal AF. 124 The role of statins in prevention of AF was further shown in a metaanalysis by Fang et al 125 Although our previous randomized controlled trial of highintensity atorvastatin therapy for prevention of atrial fibrillation postpulmonary catheter ablation was negative (125 patients), 126 a very recent meta-analysis rate in 4 pooled randomized controlled trials (488 patients), including ours, 127 did show that statins significantly lowered recurrence of AF postcatheter ablation. Accordingly, large-scale, high-quality randomized controlled clinical trials investigating statins and other common therapeutic targets for both AF primary or secondary prevention and endothelial function improvement are certainly warranted.…”

Section: Af Endothelial Dysfunction and Strokementioning

confidence: 67%

Atrial Fibrillation and Endothelial Dysfunction

Corban

Toya

Ahmad

et al. 2021

Mayo Clinic Proceedings

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Atrial fibrillation (AF) is the most common cardiac arrhythmia, and coronary atherosclerosis is the leading cause of death in the United States and worldwide. Endothelial dysfunction is the earliest clinically detectable form of atherosclerosis. Control of shared AF and coronary atherosclerosis risk factors improves both AF-free survival and vascular endothelial function. Decades of AF research have yielded fundamental insight into AF pathophysiology, but current pharmacological and catheter-based invasive AF therapies have limited long-term efficacy and substantial side effects, possibly because of incomplete understanding of underlying complex AF pathophysiology. We hereby discuss potential mechanistic links between endothelial dysfunction and AF (risk-factoreassociated systemic inflammation and oxidative stress, myocardial ischemia, common gene variants, vascular shear stress, and fibroblast growth factor-23), explore a potential new vascular dimension to AF pathophysiology, highlight a growing body of evidence supporting an association between systemic vascular endothelial dysfunction, AF, and stroke, and discuss potential common effective therapies.

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Section: Af Endothelial Dysfunction and Strokementioning

confidence: 67%

Atrial Fibrillation and Endothelial Dysfunction

Corban

Toya

Ahmad

et al. 2021

Mayo Clinic Proceedings

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“…More methods of obtaining valid MR estimates when using invalid instruments are required. [38] on IHD, stroke and AF using Mendelian randomization applied to the CARDIoGRAMplusC4D 1000 Genomes based GWAS of IHD [39], UK Biobank summary statistics from SAIGE for IHD and stroke [42], MEGASTROKE [40] for stroke and a study by Nielsen et al [41] for AF and the effects of statins and PCSK9 inhibitors on the same outcomes from meta-analysis of RCTs [30,32,36,37] Estimates from…”

Section: Resultsmentioning

confidence: 99%

“…Statins and PCSK9 inhibitors are well-established interventions for cardiovascular disease, which reduce low density lipoprotein (LDL)-cholesterol, IHD [29][30][31], stroke [29][30][31] and atrial fibrillation (AF) [32].…”

Section: Illustrative Examplementioning

confidence: 99%

“…AF may also be a consequence of IHD. Statins also appear to have a greater effect on overall survival than PCSK9 inhibitors [30,32,36,37]. As such, bearing in mind Figures 1d and 1e, greater bias would be expected when using MR to assess effects of harmful exposures on stroke and AF than on IHD, for studies with participants recruited at older ages and possibly more for genetically predicted statins than PCSK9 inhibitors.…”

Section: Illustrative Examplementioning

confidence: 99%

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Use of multivariable Mendelian randomization to address biases due to competing risk before recruitment

Schooling

Lopez

Zhao

et al. 2019

Preprint

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BackgroundMendelian randomization (MR) provides unconfounded estimates. MR is open to selection bias particularly when the underlying sample is selected on surviving the genetically instrumented exposure and other conditions that share etiology with the outcome (competing risk before recruitment). Few methods to address this bias exist.MethodsWe use directed acyclic graphs to show this selection bias can be addressed by adjusting for common causes of survival and outcome. We use multivariable MR to obtain a corrected MR estimate, specifically, the effect of statin use on ischemic stroke, because statins affect survival and stroke typically occurs later in life than ischemic heart disease so is open to competing risk.ResultsIn univariable MR the genetically instrumented effect of statin use on ischemic stroke was in a harmful direction in MEGASTROKE and the UK Biobank (odds ratio (OR) 1.33, 95% confidence interval (CI) 0.80 to 2.20). In multivariable MR adjusted for major causes of survival and ischemic stroke, (blood pressure, body mass index and smoking initiation) the effect of statin use on stroke in the UK Biobank was as expected (OR 0.81, 95% CI 0.68 to 0.98) with a Q-statistic indicating absence of genetic pleiotropy or selection bias, but not in MEGASTROKE.ConclusionMR studies concerning late onset chronic conditions with shared etiology based on samples recruited in later life need to be conceptualized within a mechanistic understanding, so as to any identify potential bias due to competing risk before recruitment, and to inform the analysis and interpretation.

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“…It is associated with B-type natriuretic peptide levels (BNP), adiponectin, insulin, and free fatty acids. Studies have shown that surgical epicardial LAA closure can lead to downregulation of the adrenergic system and RAAS ( 29 , 30 ).…”

Section: Discussionmentioning

confidence: 99%

The Association of Left Atrial Appendage Morphology to Atrial Fibrillation Recurrence After Radiofrequency Ablation

Gong

Zhou

et al. 2021

Front. Cardiovasc. Med.

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Objective: The probability of late recurrent atrial fibrillation (AF) after radiofrequency ablation (RFA) has not yet been fully clarified. This study aims to study the association of left atrial appendage (LAA) morphology with AF recurrence after RFA.Methods: We retrospectively enrolled 84 patients (24 patients had persistent AF, 60 patients had paroxysmal AF) who underwent RFA in Shanghai East Hospital from June 2014 to May 2018. The mean follow-up of these patients was 618.6 days. According to preoperative transesophageal echocardiography (TEE), the morphology feature of LAA was classified and evaluated by two classification methods. The first method was divided into chicken-wing, windsock, cactus, and cauliflower, and the second method was divided into one lobe, two lobes, and multiple lobes. The correlation between morphological feature of LAA and the recurrence rate of AF after RFA was analyzed.Results: During follow-up, 12 patients (50%) and 10 patients (16.7%) had AF recurrence in persistent and paroxysmal AF, respectively. The LAA morphology was associated with the recurrence of AF after RFA with the chicken-wing highest recurrence risk (68.2%). The structure type of LAA was also related to the AF recurrence rate (p < 0.01). Compared with one lobe and multiple lobes, two lobes (recurrence, 47.6%) were more likely associated with the recurrence of AF (p < 0.02). Logistic regression analysis showed that the chicken-wing group had a higher risk of recurrence after RFA (OR = 8.13, p = 0.004), and the windsock group had a lower risk of recurrence (OR = 0.17, p = 0.002).Conclusion: The morphological feature of LAA is related to the recurrence risk of AF after RFA. LAA morphology assessment can predict the risk of AF recurrence.

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The effect of statins on the recurrence rate of atrial fibrillation after catheter ablation: A meta‐analysis

Abstract: Statin use was associated with a significantly lower AF recurrence rate in RCTs but not in the whole analysis and the observational studies.

Cited by 17 publications

References 28 publications

Atrial Fibrillation and Endothelial Dysfunction

Atrial Fibrillation and Endothelial Dysfunction

Use of multivariable Mendelian randomization to address biases due to competing risk before recruitment

The Association of Left Atrial Appendage Morphology to Atrial Fibrillation Recurrence After Radiofrequency Ablation

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