Atorvastatin prevents atrial fibrillation in patients with bradyarrhythmias and implantation of an atrial-based or dual-chamber pacemaker: a prospective randomized trial.
BACKGROUND
Increasing evidence suggests that atrial fibrillation (AF) is an inflammatory disease. Statins is an anti-inflammatory agent. The present study was conducted to test the efficacy of atorvastatin in preventing paroxysmal AF or atrial high rate episodes (AHEs) in patients with bradyarrhythmias and implantation of an atrial-based or dual-chamber pacemaker.


METHODS
The effect of atorvastatin on time to the first attack of AF or AHE (> or =180 per minute and > or =1 or 10 minutes), which was accurately detected by pacemaker interrogation, was evaluated in an open-label prospective randomized design for 1 year of follow-up.


RESULTS
Fifty-two patients (23 males, 70 +/- 13 years old) were randomized to the statin group (atorvastatin 20 mg/d) and 54 (25 males, 72 +/- 13 years old) to the nonstatin group. Event-free survivals from AHE > or =1 minute were not significantly different between the 2 groups (log-rank P = .410). However, patients in the nonstatin group were more likely to develop AHE > or =10 minutes than those in the statin group (log-rank P = .028). Atrial high rate episode > or =10 minutes occurred in 3 (5.8%) of 51 patients in the statin group after 1 year of follow-up, and 10 (19.2%) of 52 patients (odds ratio 0.26, P = .041) in the nonstatin group. The mean left atrial volume of the statin group was significantly lower than that of the nonstatin group at the end of follow-up (39.7 +/- 1.7 vs 43.7 +/- 1.9 mL, P < .0001).


CONCLUSIONS
The present study demonstrated the efficacy of atorvastatin in preventing significant AF (> or =10 minutes) and left atrial enlargement in patients with bradyarrhythmias and implantation of a pacemaker.
Tsai
Chia-Ti
CT
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Lai
Ling-Ping
LP
Hwang
Juey-Jen
JJ
Wang
Yi-Chih
YC
Chiang
Fu-Tien
FT
Lin
Jiunn-Lee
JL
D000368:Aged; D000369:Aged, 80 and over; D000069059:Atorvastatin; D001281:Atrial Fibrillation / Q000401:mortality / Q000517:prevention & control*; D001919:Bradycardia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010138:Pacemaker, Artificial; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011758:Pyrroles / Q000008:administration & dosage*; D012016:Reference Values; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin