The impact of statin use on atrial fibrillation

Abstract

The aim of the present systematic review is to present an overview of the evidence linking atrial fibrillation (AF), inflammation and oxidative stress, with emphasis on the potential of statins to decrease the incidence of different types of AF, including new-onset AF, after electrical cardioversion (EC) and after cardiac surgery. Observational and clinical trials have studied the impact of statin therapy on new-onset, post-EC or postoperative AF. Data from different observational trials have shown that treatment with statins significantly reduces the incidence of new-onset AF in the primary and secondary prevention. The data are insufficient to recommend the use of statins before EC. Finally, perioperative statin therapy may represent an important non-antiarrhythmic adjunctive therapeutic strategy for the prevention of postoperative AF.

Atrial septal defect closure is associated with a reduced prevalence of atrial tachyarrhythmia in the short to medium term: a systematic review and meta-analysis

“…Ion channel expression has been shown to revert in those who electrically cardiovert,52 53 and reversal of electrical remodelling is known to occur sooner than structural reversal,57 with animal studies showing almost immediate electrical reverse remodelling but persistent structural remodelling at four months 58. This is supported by our finding of a larger effect of ASD closure on AT at mid-term follow-up (OR 0.47, 95% CI 0.36 to 0.62) compared to the immediately post-repair period (OR 0.80, 95% CI 0.66 to 0.97), when remodelling has not yet occurred 57 60. However, the effect of ASD repair was lost at longer follow-up, suggesting that other mechanisms are in action (eg, ageing).…”

“…As the best available evidence was evaluated within a robust statistical framework, this study provides accurate estimates of treatment effects in a clinical group in which adequately powered experimental studies are impossible due to the low prevalence of this condition and the established role of ASD closure in the management of these patients, which would not allow randomisation to a non-repair (placebo) arm 36 60…”

Use of Statins and Antihypertensive Medications in Relation to Risk of Long-standing Persistent Atrial Fibrillation

“…Our analysis did not provide support for healthy user bias, but also did not rule it out as an explanation. Points in favor of a modest protective effect of current statin use include the dose-dependent relationship we observed in this study, biologic plausibility of an effect of statins on AF pathogenesis through reducing inflammation and oxidative stress, 28 and consistency with recent meta-analyses which showed lower risk of AF recurrence among statin users. 12,14,15 Our study provides new information by focusing on longstanding persistent AF, which may be a more severe outcome than recurrent AF.…”

Pursuing Sinus Rhythm in Patients With Persistent Atrial Fibrillation

“…Maintenance of sinus rhythm after ablation may also differ by procedural technique, particularly with less extensive ablation than that used by Matsuo et al (28). The investigators do not provide data on the use of concurrent drugs that target potential mediators of structural remodeling (angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, aldosterone antagonists, and statins), and may favorably influence rhythm control (31,32). Finally, use of alternative surface ECG indexes of AF organization and complexity (30), biomarkers of ongoing structural remodeling (33), or direct imaging of the extent and distribution of atrial fibrosis (34) may further refine our predictions of successful outcomes.…”