Effect of Eplerenone on Maintenance of Sinus Rhythm After Catheter Ablation in Patients With Long-Standing Persistent Atrial Fibrillation

Ikoma, Yoko; Yamasaki, Hiro; Naruse, Yoshihisa; Yoshida, Kentaro; Kaneshiro, Takashi; Murakoshi, Nobuyuki; Igarashi, Miyako; Kuroki, Kenji; Machino, Takeshi; Xu, DongZhu; Kunugita, Fusanori; Sekiguchi, Yukio; Sato, Akira; Tada, Hiroshi; Aonuma, Kazutaka

doi:10.1016/j.amjcard.2012.12.020

Cited by 32 publications

(21 citation statements)

References 28 publications

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“…Finally, the current study showed no association between MRA use and slowing of AF progression, despite other clinical evidence suggesting improved rhythm control with MRA 10, 15, 16, 17. There are several differences between this and other studies.…”

Section: Discussioncontrasting

confidence: 94%

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Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry

Fudim

Liu

Shrader

et al. 2018

JAHA

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BackgroundMineralocorticoid receptor antagonist (MRA) therapy may be beneficial to patients with atrial fibrillation (AF), but little is known about their use in patients with AF and subsequent outcomes.Methods and ResultsIn order to better understand MRA use and subsequent outcomes, we performed a retrospective cohort study of the contemporary ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry. AF progression and cardiovascular outcomes were compared using propensity‐matched Cox proportional hazards modeling according to MRA use at baseline and new MRA use at follow‐up versus patients with no MRA use. Among 7012 patients with nonpermanent AF, 320 patients were taking MRA at enrollment, and 416 patients initiated MRA use during follow‐up. The mean patient age was 72.5 years, 56.3% were men, and 70.4% had paroxysmal AF. Among all patients taking MRAs, 434 (59.0%) had heart failure, 655 (89.0%) had hypertension, and 380 (51.6%) had both. After adjustment, new MRA use was not associated with reduced AF progression (hazard ratio, 1.18; 95% confidence interval, 0.88–1.58; P=0.27) but showed a trend towards lower risk of stroke, transient ischemic attack, or systemic embolism (hazard ratio, 0.17; 95% confidence interval, 0.02–1.23; P=0.08). Results were similar for a comparison of new MRA users and baseline MRA users compared with nonusers.ConclusionsIn community‐based outpatients with AF, the majority of MRA use was for heart failure and hypertension. MRA use also trended towards lower adjusted stroke risk. Future studies should test the hypothesis that MRA use may decrease the risk of stroke in patients with AF.

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Section: Discussioncontrasting

confidence: 94%

“…Consequently, the absence of any apparent association with reduced AF progression may be explained by the fact that disease substrate may already be too advanced to harness any potential benefit of MRA therapy. Despite this concern, some studies have shown reduction in recurrent AF with MRA therapy in patients with persistent AF 10, 16, 17…”

Section: Discussionmentioning

confidence: 99%

Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry

Fudim

Liu

Shrader

et al. 2018

JAHA

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“…Roli antagonistów aldosteronu w leczeniu AF nie oceniano dokładnie u ludzi. Mimo że wstępne dowody z prób klinicznych z użyciem eplerenonu są zachęcające, to w odniesieniu do prewencji pierwotnej [243] nie ma obecnie mocnych dowodów wskazujących na to, by można było sformułować jakiekolwiek zalecenie dotyczące stosowania antagonistów aldosteronu we wtórnej prewencji AF [699][700][701].…”

Section: Antyarytmiczne Działanie Leków Nieantyarytmicznychunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,380

4,206

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“…In a small retrospective observational study of 161 patients undergoing catheter ablation for persistent or permanent AF, those patients treated with eplerenone had a greater freedom from AF at 2 years follow-up. 98 A small open-label trial of 164 patients with paroxysmal AF on a β-blocker randomized to spironolactone or placebo with or without enalapril did show merit. 99 There was a significant reduction in recurrent AF over the 12-month trial period and decreased progression to permanent AF.…”

Section: Medications For Maintenance Of Srmentioning

confidence: 97%

Atrial Fibrillation: Antiarrhythmic Therapy

Psotka¹,

Lee²

2014

Current Problems in Cardiology

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Effect of Eplerenone on Maintenance of Sinus Rhythm After Catheter Ablation in Patients With Long-Standing Persistent Atrial Fibrillation

Cited by 32 publications

References 28 publications

Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry

Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Atrial Fibrillation: Antiarrhythmic Therapy

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