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Clinical Articles

Cardioversion- statin doesn’t maintain sinus rhythm

Statins have antiarrhythmic effects, which may be due to their anti-inflammatory properties. A multicentre study from Sweden (1) evaluated the effect of atorvastatin in achieving and maintaining sinus rhythm (SR) after electrical cardioversion (CV) in patients with persistent atrial fibrillation (AF).

cardioversion-ecg

A total of 234 patients were included in the study. They had persistent AF (duration seven days or more), and an indication for cardioversion. Patients aged over 80 years, those with paroxysmal AF and those already on lipid-lowering therapy or class I or class III antiarrhythmic treatment were excluded from the study. The primary end point was the number of patients in SR (assessed by ECG) 30 days after CV. Patients were assigned to atorvastatin 40 mg bd or placebo, and treatment was started at least 14 days before the CV.

Demographic and clinical characteristics were well matched at baseline for the two groups: mean age was 65 years, three quarters were male, and the mean body mass index was 29 kg/m2.

At day 2 after CV, 75% of patients receiving atorvastatin and 70% of patients receiving placebo were in SR (p=0.45). Thirty days after CV, intention-to-treat analysis showed that 51% of patients in the atorvastatin group and 42% in the placebo group were in SR (odds ratio 1.44, 95% CI 0.8-2.44, p=0.18). Fewer patients in the atorvastatin group (21%) compared to the placebo group (30%) had subjective sensations of arrhythmia (p=0.12).

Statin treatment was therefore not statistically superior to placebo with in maintaining SR at 30 days after CV in this group of patients.

The positive effects of statins in reducing cardiovascular morbidity and mortality may be a result of their lipid-lowering, anti-inflammatory, antiproliferative and anti-oxidative properties. (Inflammation is believed to be involved in AF.) These beneficial effects are likely to be more prominent in patients with ischaemic heart disease (IHD), and this particular study included only 4% of patients with IHD—most patients with IHD are treated with statins, an exclusion criterion in this study.

Results of this trial do not support use of atorvastatin as an alternative antiarrhythmic treatment in this cohort of patients.

Reference

  1. Almroth H, Höglund N, Boman K et al. Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebo-controlled multicentre study. Eur Heart J 2009; 30: 827-33.

Published on: June 7, 2009

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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