title: Effect of spironolactone on patients with atrial fibrillation and structural heart disease.
abstract: BACKGROUND
  Several studies have shown that the modulation of fibrotic scar in cardiac diseases has beneficial effects on cardiac arrhythmias. In addition, recent reports suggest a potential role of mineralocorticoid receptor upregulation in atrial fibrillation (AF). The role of spironolactone, a mineralocorticoid receptor blocker and a potent antifibrotic agent, in AF is as yet unexplored. The aim of this study was to determine if spironolactone, a mineralocorticoid receptor blocker with potent antifibrotic properties, has beneficial effects on AF.
  
  
  OBJECTIVE
  Spironolactone therapy in patients with atrial fibrillation provides additional clinical benefits in addition to the current conventional pharmacological agents.
  
  
  METHODS
  A comprehensive retrospective analysis was performed on 83 patients with AF, including 23 who were treated with spironolactone for ≥3 months. The combined primary outcome of hospitalization for AF or direct current cardioversion (DCCV) was compared between patients treated with spironolactone in addition to the usual care for AF and those receiving conventional medical therapy alone.
  
  
  RESULTS
  Patients receiving spironolactone had significantly fewer primary outcome events (AF-related hospitalizations or DCCV) (22% vs 53%, P = 0.027).
  
  
  CONCLUSIONS
  Spironolactone therapy is associated with a reduction in the burden of AF, as reflected by a combination of hospitalizations for AF and DCCV. Larger randomized controlled studies should be performed to evaluate the efficacy and safety of spironolactone as an adjunctive therapy for patients with AF.
authors.affiliation: Department of Internal Medicine/Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Williams
authors.forename: James A
authors.initials: JA
authors.lastname: deLemos
authors.forename: Vassilis
authors.initials: V
authors.lastname: Dimas
authors.forename: Joan
authors.initials: J
authors.lastname: Reisch
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Hill
authors.forename: R Haris
authors.initials: RH
authors.lastname: Naseem
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D016009:Chi-Square Distribution; D004554:Electric Countershock; D005260:Female; D005355:Fibrosis; D006331:Heart Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013148:Spironolactone / Q000627:therapeutic use*; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone