Non-antiarrhythmic agents for prevention of postoperative atrial fibrillation: role of statins.
OBJECTIVE
Atrial fibrillation is the most common arrhythmia following cardiac surgery, having both serious medical and socioeconomic consequences. Although there are established antiarrhythmic agents for preventing and treating postoperative atrial fibrillation, these therapies are neither 100% reliable, nor without risks and limitations. Thus, there remains a strong need for non-antiarrhythmic, adjunctive therapies for the prevention of postoperative atrial fibrillation.


RESULTS
Long-term statin administration in ambulatory patients is associated with a reduced risk of adverse cardiovascular events, including death, myocardial infarction, stroke, renal dysfunction and atrial fibrillation. Recent evidence suggests, however, that statins may also reduce the risk of acute adverse outcomes following invasive procedures, including postoperative atrial fibrillation. Although the exact mechanisms by which statins may reduce postoperative atrial fibrillation are unclear, accumulating evidence suggests that statins exert multiple effects independent of their effect on LDL cholesterol. For example, in patients with acute coronary syndromes, statin therapy has been shown to modulate remodeling of the cardiac extracellular matrix and to reduce markers of inflammation, including C-reactive protein, serum amyloid A, tumor necrosis factor-alpha, and IL-6.


CONCLUSIONS
Perioperative statin therapy may represent an important non-antiarrhythmic, adjunctive therapeutic strategy for the prevention of postoperative atrial fibrillation.
Blanchard
Lawrence
L
Baylor College of Medicine, Division of Cardiovascular Anesthesia, Texas Heart Institute, St Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Collard
Charles D
CD
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D012307:Risk Factors
D000889:Anti-Arrhythmia Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors