Review
Copyright ©2010 Baishideng Publishing Group Co.
World J Cardiol. Aug 26, 2010; 2(8): 243-250
Published online Aug 26, 2010. doi: 10.4330/wjc.v2.i8.243
Table 1 Statins and atrial fibrillation
Ref.Study designSubjectsConclusion
Kumagai et al[21]ProspectiveInterventional canine sterile pericarditis model; atorvastatinAtorvastatin group had lower CRP, shorter duration of AF, less inflammation in atrial tissues
Siu et al[25]Retrospective62 lone persistent AF, statin vs controlLower recurrence rate in the statin group
Tveit et al[35]Prospective114 patients undergoing electrical cardioversion; pravastatin vs nonePravastatin did not reduce the recurrence rate of AF
Young-Xu et al[26]Prospective449 patients with CAD were followed for 5 yrDevelopment of AF was lower in statin group
Ozaydin et al[24]Prospective48 patients undergoing cardioversion; atorvastatin vs none81% relative risk reduction in AF recurrence
Ozaydin et al[31]Observational264 patients undergoing CABG surgery; any statinStatin group had lower AF rates
Patti et al[30] (ARMYDA-3)Prospective200 patients undergoing CABG surgery; atorvastatin vs placebo61% reduction in the odds of AF
García-Fernández et al[36]Prospective52 patients undergoing cardioversion; atorvastatin vs noneNo significant difference in recurrence rate of AF
Ramani et al[27]Retrospective1526 patients with ACS; various statins43% reduction in the odds
Humphries et al[37]Prospective, observational625 patiens undergoing cardioversion; any statin74% reduction in the odds of AF with β-blocker; no effect alone
Hanna et al[42]Data from a multicenter registry25 268 patients with LVEF ≤ 40%Lipid-lowering drug use was associated with reduced odds of AF
Fauchier et al[43]Meta-analysisSix studies with 3557 patientsStatins were significantly associated with a decreased risk of AF (P = 0.02)
Benefit of statins was more marked in secondary prevention of AF
Liu et al[44]Meta-analysisSix randomized and 10 observational studies with 7041 patientsNo significant effect of statins on AF development (P = 0.09). Observational studies showed that statin use decrease the relative risk for AF by 23%. This effect was greatest in the postoperative patients
Patel et al[46]Meta-analysis14 trials with 7402 patientsStatin decreased AF rates by 45%. Decrease was most prominent in postoperative AF
Marín et al[32]Prospective, observational234 patients undergoing CABG surgery; any statin48% reduction in the odds of AF
McLean et al[40]Two large, randomized trials: PROVE IT-TIMI 22 and A to Z trial8659 patients with ACS; low- vs high-dose statin therapyNeither study showed decreased AF risk with high-dose statin therapy
Lertsburapa et al[33]Observational555 patients undergoing CABG surgery; any statin40% reduction in the odds of AF
Kourliouros et al[34]Retrospective680 patients undergoing CABG surgery; atorvastatin and simvastatinImproving benefits with higher dose
Virani et al[39]Retrospective4044 patients undergoing CABG surgery; any statinNo effect
Adabag et al[41]Cohort13 783 CAD patientsNo difference in AF incidence with statin treatment (P = 0.09). However, AF was reduced in a subgroup of patients with congestive heart failure (P = 0.04)
Table 2 Polyunsaturated fatty acids and atrial fibrillation
Ref.Study designSubjectsConclusion
Physicians’ Health Study[54]Prospective17 679 patients (epidemiological study)Although statistically insignificant, AF risk is higher in PUFAs group
Danish study[53]Prospective47 949 patients (epidemiological study)Although statistically insignificant, AF risk is higher in PUFAs group
Rotterdam study[55]Prospective5184 patients (epidemiological study)Although statistically insignificant, AF risk is higher in PUFAs group
Mozaffarian et al[51]Prospective4815 patients (epidemiological study)Although statistically insignificant, AF risk is higher in fried fish/fish sandwich group
Significantly, AF risk is lower in broiled/baked fish group
Calò et al[48]Prospective160 patients undergoing CABG surgeryAF risk is significantly lower in PUFAs group
Saravanan et al[49]ProspectivePatients undergoing CABG surgeryAF risk is significantly lower in PUFAs group
Table 3 Corticosteroids and atrial fibrillation
Ref.Study designSubjectsConclusion
Chaney et al[57]Prospective60 patients undergoing CABG surgery; methylprednisoloneNo effects of steroids on in the incidence of AF
Yared et al[58]Randomized235 patients undergoing CABG or valve surgeryDexamethasone decreased incidence of new-onset AF
Yared et al[59]Randomized78 patients undergoing CABG or valve surgeryDexamethasone did not decrease incidence of new-onset AF and inflammation
Dernellis et al[17]Randomized104 patients undergoing electrical cardioversionMethylprednisolone decreased plasma CRP levels and AF recurrence
Goldstein et al[61]Animal studyCanine sterile pericarditis modelPrednisone treatment decreased inflammation, and eliminated atrial arrhythmia inducibility
Halonen et al[60]Randomized241 patients undergoing CABG or valve surgeryCorticosteroids decreased the incidence of postoperative AF and serum CRP levels
Baker et al[62]Meta-analysisNine studies with 990 patients undergoing CABG or valve surgeryPositive effects of perioperative corticosteroid use on AF occurrence
Table 4 Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and atrial fibrillation
Ref.Study designSubjectsConclusion
Murray et al[76]Prospective study, retrospective analysis732 patients; AF rhythm controlNo difference in AF recurrence
Madrid et al[71]Prospective (electrical cardioversion)154 patients; amiodarone only vs amiodarone + irbesartanRecurrence of AF lower in irbesartan group
Zaman et al[73]Prospective (electrical cardioversion)47 patients; ACEI vs no ACEI groupNumber of defibrillation attempts required for successful cardioversion was less in ACEI group
Ueng et al[72]Prospective (electrical cardioversion)125 patients; amiodarone only vs amiodarone + enalaprilEnalapril group had decreased rate of recurrence
Pedersen et al[65]Prospective (post-MI)1577 patients with LV dysfunction post-MI; trandolapril vs controlTrandolapril reduces AF
SOLVD[66]Prospective study, but retrospective analysis (heart failure)374 patients with depressed LV function; enalapril vs controlAF rate lower in ACEI group
Val-HeFT[78]Prospective study, retrospective analysis (heart failure)4409 patients with; valsartan vs controlARB lower incidence of AF
CHARM[77]Prospective study, retrospective analysis (heart failure)5518 patients; candesartan vs controlARB lowers incidence of AF in both normal and depressed ejection fraction
L'Allier et al[79]Retrospective (hypertension)5463 patients receiving ACEI vs 5463 patients receiving CCBThe incidence of AF was lower in ACEI group
Miceli et al[80]Retrospective (post-CABG)10 023 patients undergoing isolated CABG; ACEI vs non-ACEIACEI treatment is associated with an increased risk of post-operative AF
Madrid et al[81]Meta-analysisSeven trials involving a total of 24 849 patientsThere was a significant statistical difference in the development AF with ACEI/ARB treatment
Kalus et al[82]Meta-analysisFour trialsThere was a significant statistical difference in the development AF with ACEI/ARB treatment
Anand et al[83]Meta-analysisNine randomized controlled trialsThe use of ACEIs and ARBs had an overall effect of 18% risk reduction in new-onset AF across the trials and 43% risk reduction in patients with heart failure
Jibrini et al[84]Meta-analysis11 randomized trialsOverall, inhibition of the RAAS reduced the RR of AF by 19%. Reduction in AF was greatest in patients after electrical cardioversion and in patients with heart failure
Healey et al[85]Meta-analysis11 randomized trialsOverall, ACEIs and ARBs reduced the relative risk of AF by 28%. Reduction in AF was similar between ACEI and ARB and was greatest in patients with heart failure. Overall, there was no significant reduction in AF in patients with hypertension