title: Effect of eplerenone on maintenance of sinus rhythm after catheter ablation in patients with long-standing persistent atrial fibrillation.
abstract: Several studies have demonstrated a relation between the rennin-angiotensin-aldosterone system and atrial fibrillation (AF), but there are no reports on the effect of eplerenone, a selective aldosterone blocker, on the prevention of AF recurrence after radiofrequency catheter ablation (RFCA). The aim of this study was to evaluate the effects of eplerenone on clinical outcomes after RFCA in patients with long-standing persistent AF. A total of 161 consecutive patients with long-standing persistent AF (sustained AF duration 1 to 20 years, mean 3.4 ± 3.8) who underwent RFCA were investigated. Eplerenone was used in 55 patients and not used in the remaining 106 patients. Other conventional pharmacologic agents, including angiotensin-converting enzyme inhibitors or angiotensin type 1 receptor blockers, were used equally in the 2 groups. After 24 months of follow-up, 47% of the patients were free from AF recurrence. The rate of freedom from AF recurrence was significantly greater in the eplerenone group (60%) than in the noneplerenone group (40%) (p = 0.011). By univariate analysis, the duration of sustained AF (p <0.001), left atrial diameter (p = 0.010), left atrial volume index (p = 0.017), and early AF recurrence (p <0.001) were significantly associated with AF recurrence, and the use of eplerenone was associated with maintenance of sinus rhythm after RFCA (p = 0.022). Multivariate Cox regression analysis showed that longer duration of sustained AF (>3 years) (p <0.001) and early AF recurrence (p <0.001) were significantly associated with AF recurrence, and only eplerenone therapy significantly improved maintenance of sinus rhythm (p = 0.017). In conclusion, eplerenone significantly improved maintenance of sinus rhythm after RFCA in patients with long-standing persistent AF.
authors: Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
authors: Yoko
authors: Y
authors: Ito
authors: Hiro
authors: H
authors: Yamasaki
authors: Yoshihisa
authors: Y
authors: Naruse
authors: Kentaro
authors: K
authors: Yoshida
authors: Takashi
authors: T
authors: Kaneshiro
authors: Nobuyuki
authors: N
authors: Murakoshi
authors: Miyako
authors: M
authors: Igarashi
authors: Kenji
authors: K
authors: Kuroki
authors: Takeshi
authors: T
authors: Machino
authors: Dongzhu
authors: D
authors: Xu
authors: Fusanori
authors: F
authors: Kunugita
authors: Yukio
authors: Y
authors: Sekiguchi
authors: Akira
authors: A
authors: Sato
authors: Hiroshi
authors: H
authors: Tada
authors: Kazutaka
authors: K
authors: Aonuma
mesh_terms: D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D017115:Catheter Ablation / Q000379:methods*; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D015716:Electrocardiography, Ambulatory; D000077545:Eplerenone; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone