Do statins have an antiarrhythmic activity?

Abstract

Sudden cardiac death, which is mainly associated with the presence of life-threatening ventricular arrhythmias, is a common 'killer' among patients with coronary artery disease. Moreover, atrial fibrillation is the most common arrhythmia encountered in the clinical practice. The beneficial effect of statins on cardiovascular morbidity and mortality is well-established, while the exact role of this class of drugs against arrhythmias remains unclear. This review discusses the effect of statin treatment on arrhythmias that are commonly seen in the clinical setting. The underlying pathophysiological mechanisms are also overviewed. Compelling evidence from the majority of the studies reviewed shows that statins exhibit a protective effect against the occurrence of ventricular arrhythmias and atrial fibrillation.

Spectrum of Pleiotropic Effects of Statins in Heart Failure

“…There is also evidence that statins play an important role in preventing atrial and cardiac arrhythmias, which will be discussed in the accompanying review by Olshansky in this issue. [59] The question that remains is whether the aggregate of these beneficial effects observed in the laboratory will translate into beneficial effects in patients with heart failure, and if so, which of the potential spectrum of mechanisms will prove to be most important. Hopefully, these issues may potentially be gleaned from ongoing large scale clinical trials.…”

Statins and sudden cardiac death - mini review on available data

“…Some studies have suggested that statins might have some direct antiarrhythmic effects [16,21] . Possible mechanisms which could explain the antiarrhythmic properties might involve the capacity of statins for NO-dependent endothelial function regulation, inflammation and oxidative stress reduction, highrisk plaque rupture and ischemia/reperfusion myocardial injury prevention, improvement in heart rate variability and decreased QT dispersion [14,22] . Recently Rahimi et al (2012) in a meta-analysis of 29 RCTs concluded that statin therapy did not significantly reduce the risk of ventricular tachyarrhythmia and cardiac arrest, but was responsible for a significant 10% reduction in SCDs [23] .…”

“…Besides their lipid-lowering effects, statins exhibit pleiotropic properties such as anti-inflammatory [10] , antioxidant [11] , antihypertrophic and antifibrotic effects, which might play a role in CV protection [12] . Statins can slow the progression or even induce regression of atherosclerosis [13] , which may reduce myocardial ischemia, which can cause ventricular arrhythmias, and in consequence reduce the risk of SCD [14] . Large scale clinical trials indicated that statins reduce CV morbidity and mortality in high-risk populations [15] .…”

Atrial Remodeling And Atrial Fibrillation: Mechanistic Interactions And Clinical Implications

“…167,173,174 Recent meta-analysis by Liu et al 167 on this issue showed different results between randomized clinical trials (RCTs) and observational studies, suggesting that statins maybe effective in AF prevention, especially in postoperative patients. Therefore, larger RCTs with longer follow-up periods and more sensitive methods of AF detection are urgently needed.…”