Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebo-controlled multicentre study.

AIMS To evaluate the effect of atorvastatin in achieving stable sinus rhythm (SR) 30 days after electrical cardioversion (CV) in patients with persistent atrial fibrillation (AF). METHODS AND RESULTS The study included 234 patients. The patients were randomized to treatment with atorvastatin 80 mg daily (n = 118) or placebo (n = 116) in a prospective, double-blinded fashion. Treatment was initiated 14 days before CV and was continued 30 days after CV. The two groups were well-balanced with respect to baseline characteristics. Mean age was 65 +/- 10 years, 76% of the patients were male and 4% had ischaemic heart disease. Study medication was well-tolerated in all patients but one. Before primary endpoint 12 patients were excluded. In the atorvastatin group 99 patients (89%) converted to SR at electrical CV compared with 95 (86%) in the placebo group (P = 0.42). An intention-to-treat analysis with the available data, by randomization group, showed that 57 (51%) in the atorvastatin group and 47 (42%) in the placebo group were in SR 30 days after CV (OR 1.44, 95%CI 0.85-2.44, P = 0.18). CONCLUSION Atorvastatin was not statistically superior to placebo with regards to maintaining SR 30 days after CV in patients with persistent AF.

[1]  L. Fauchier,et al.  Antiarrhythmic effect of statin therapy and atrial fibrillation a meta-analysis of randomized controlled trials. , 2008, Journal of the American College of Cardiology.

[2]  V. Pasceri,et al.  Randomized Trial of Atorvastatin for Reduction of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: Results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) Study , 2006, Circulation.

[3]  R. Berger,et al.  Effects of statin therapy on arrhythmic events and survival in patients with nonischemic dilated cardiomyopathy. , 2006, Journal of the American College of Cardiology.

[4]  L. Jordaens,et al.  Coronary risk factors and inflammation in patients with coronary artery disease and internal cardioverter defibrillator implants. , 2006, International journal of cardiology.

[5]  G. Amit,et al.  Association of statin therapy and the risk of atrial fibrillation in patients with a permanent pacemaker , 2006, Clinical cardiology.

[6]  E. Varol,et al.  Effect of atorvastatin on the recurrence rates of atrial fibrillation after electrical cardioversion. , 2006, The American journal of cardiology.

[7]  J. Ruskin,et al.  Reduction in ventricular tachyarrhythmias with statins in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. , 2006, Journal of the American College of Cardiology.

[8]  J. Dernellis,et al.  Effect of C-reactive protein reduction on paroxysmal atrial fibrillation. , 2005, American heart journal.

[9]  H. Thaler,et al.  Statin use is associated with a reduction in atrial fibrillation after noncardiac thoracic surgery independent of C-reactive protein. , 2005, Chest.

[10]  Wei Dong,et al.  Effect of statin use within the first 24 hours of admission for acute myocardial infarction on early morbidity and mortality. , 2005, The American journal of cardiology.

[11]  E. Toft,et al.  Statins, Ventricular Arrhythmias and Heart Rate Variability in Patients with Implantable Cardioverter Defibrillators and Coronary Heart Disease , 2005, Cardiology.

[12]  Philip J. Barter,et al.  Intensive lipid lowering with atorvastatin in patients with stable coronary disease. , 2005, The New England journal of medicine.

[13]  Gianni Tognoni,et al.  Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). , 2005, American heart journal.

[14]  David O. Martin,et al.  Effect of statin therapy on risk of ventricular arrhythmia among patients with coronary artery disease and an implantable cardioverter-defibrillator. , 2005, The American journal of cardiology.

[15]  J. Gore,et al.  Early withdrawal of statin therapy in patients with non-ST-segment elevation myocardial infarction: national registry of myocardial infarction. , 2004, Archives of internal medicine.

[16]  W. Vaughn,et al.  Statins Are Associated With a Reduced Incidence of Perioperative Mortality After Coronary Artery Bypass Graft Surgery , 2004, Circulation.

[17]  Bruce M Psaty,et al.  Fish intake and risk of incident atrial fibrillation. , 2004, Circulation.

[18]  J. Dernellis,et al.  Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation. , 2004, European heart journal.

[19]  A. Tveit,et al.  Analysis of pravastatin to prevent recurrence of atrial fibrillation after electrical cardioversion. , 2004, The American journal of cardiology.

[20]  Bruce M Psaty,et al.  Inflammation as a Risk Factor for Atrial Fibrillation , 2003, Circulation.

[21]  R. Goldberg,et al.  Usefulness of statin drugs in protecting against atrial fibrillation in patients with coronary artery disease. , 2003, The American journal of cardiology.

[22]  C. Lau,et al.  Prevention of atrial fibrillation recurrence by statin therapy in patients with lone atrial fibrillation after successful cardioversion. , 2003, The American journal of cardiology.

[23]  A. Hallstrom,et al.  Are lipid-lowering drugs also antiarrhythmic drugs? An analysis of the Antiarrhythmics versus Implantable Defibrillators (AVID) trial. , 2003, Journal of the American College of Cardiology.

[24]  N. Poulter,et al.  Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial☆ , 2003 .

[25]  M. Kayıkçıoğlu,et al.  The effect of statin therapy on ventricular late potentials in acute myocardial infarction. , 2003, International journal of cardiology.

[26]  A. Ducharme,et al.  Enalapril Decreases the Incidence of Atrial Fibrillation in Patients With Left Ventricular Dysfunction Insight From the Studies Of Left Ventricular Dysfunction (SOLVD) Trials , 2003, Circulation.

[27]  M. Ezekowitz,et al.  Effects of Atorvastatin on Stroke in Patients With Unstable Angina or Non-Q-Wave Myocardial Infarction: A Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Substudy , 2002, Circulation.

[28]  Cynthia A. Carnes,et al.  C-Reactive Protein Elevation in Patients With Atrial Arrhythmias: Inflammatory Mechanisms and Persistence of Atrial Fibrillation , 2001, Circulation.

[29]  J. Dernellis,et al.  C-reactive protein and paroxysmal atrial fibrillation: evidence of the implication of an inflammatory process in paroxysmal atrial fibrillation , 2001, Acta cardiologica.

[30]  D. M. Elnicki,et al.  Effect of preoperative statin therapy and cardiac outcomes after coronary artery bypass grafting. , 2000, The American journal of cardiology.

[31]  L. Jordaens,et al.  Lipid lowering drugs and recurrences of life-threatening ventricular arrhythmias in high-risk patients. , 2000, Journal of the American College of Cardiology.

[32]  L. Køber,et al.  Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. , 1999, Circulation.

[33]  J. Tardif,et al.  Cholesterol reduction rapidly improves endothelial function after acute coronary syndromes. The RECIFE (reduction of cholesterol in ischemia and function of the endothelium) trial. , 1999, Circulation.

[34]  M. Pfeffer,et al.  Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events (CARE) Investigators. , 1998, Circulation.

[35]  R. Rosenson,et al.  Antiatherothrombotic properties of statins: implications for cardiovascular event reduction. , 1998, JAMA.

[36]  U. Laufs,et al.  Upregulation of endothelial nitric oxide synthase by HMG CoA reductase inhibitors. , 1998, Circulation.

[37]  J. Tardif,et al.  Cholesterol Reduction Rapidly Improves Endothelial Function After Acute Coronary Syndromes , 1998 .

[38]  Scandinavian Simvastatin Survival Study Group.  Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) , 1994, The Lancet.

[39]  J. Slattery,et al.  Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). 1994. , 1994, Atherosclerosis. Supplements.

[40]  J. Stengård,et al.  Antibodies to glutamic acid decarboxylase as predictors of insulin-dependent diabetes mellitus before clinical onset of disease , 1994, The Lancet.

[41]  E. Antman,et al.  Propafenone versus sotalol for suppression of recurrent symptomatic atrial fibrillation. , 1993, The American journal of cardiology.

[42]  S. Juul-Möller,et al.  Sotalol versus quinidine for the maintenance of sinus rhythm after direct current conversion of atrial fibrillation. , 1990 .

[43]  A. Raviele,et al.  Antiarrhythmic Effect of Statin Therapy and Atrial Fibrillation A Meta-Analysis of Randomized Controlled Trials. , 2008, Journal of atrial fibrillation.

[44]  A. Waldo.  Angiotensin II Receptor Blockade Reduces New-Onset Atrial Fibrillation and Subsequent Stroke Compared to Atenolol: The Losartan Intervention for End Point Reduction in Hypertension (LIFE) Study , 2006 .

[45]  M. Pfeffer,et al.  Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. , 2006, American heart journal.