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

Abstract

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)

The preventive effect of statin therapy on new-onset and recurrent atrial fibrillation in patients not undergoing invasive cardiac interventions

“…Six trials examined patients with coronary artery disease [18,19,[21][22][23][24][25], six trials examined effect of statins in patients undergoing electrical conversion [26][27][28][29][30][31], four trials were on patients with MI [32][33][34][35], and four trials were undertaken in patients with pacemaker or implantable cardioverter-defibrillator (ICD) [36][37][38][39]. Two trials analyzed primary prevention of AF [17,40], one trial was on patients with heart failure [20], one trial was on AF after cerebral infarction, [41] one trial investigated in elderly patients [32] and finally one trial examined patients with left ventricular hypertrophy [42]. The included sample sizes ranged between 48 up to 89,703 patients.…”

“…We assumed that the heterogeneity in the observational trials reflected the difference in the sample size and event rate of the large versus small size studies. Hence, a step-wise exclusion of large [23,34,35] or small size trials [27,28,30,40,44] did not improve the heterogeneity.…”

Efficacy of Antiarrhythmic Drug Therapy in Preventing Recurrence of Atrial Fibrillation and Long-Term Cardiovascular Prognosis in Patients With Asymptomatic Paroxysmal Atrial Fibrillation

“…The CHADS 2 score was also significantly greater in the asymptomatic AF group (1.63 ± 1.27) than in the symptomatic AF group (1.14 ± 1.18, P < 0.05). Other demographic data showed no significant differences, including the incidence of administration of angiotensin-converting enzyme inhibitors (ACEI) or statins, 13) and the percentage of patients treated with and without antithrombotic therapy also showed no significant differences between the asymptomatic and symptomatic AF groups.…”

Prospective Comparative Study of Intravenous Cibenzoline and Disopyramide Therapy in the Treatment of Paroxysmal Atrial Fibrillation After Cardiovascular Surgery

“…Patients with paroxysmal AF were classified into the following 3 categories according to when episodes of palpitations developed: diurnal type (episodes occurred from 07:00 hours to 17:00 hours); nocturnal type (episodes occurred from 17:00 hours to 07:00 hours); and mixed type (episodes occurred both diurnally and nocturnally). 14, 15 Hypertension was defined according to the Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH2009). 16 …”