title: Effectiveness of aldosterone antagonists for preventing atrial fibrillation after cardiac surgery in patients with systolic heart failure: a retrospective study.
abstract: Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery. There exist consistent experimental and clinical data suggesting that aldosterone antagonists (AAs) may exert beneficial effects regarding electrical and structural remodeling in failing myocardium. Recently, eplerenone (EPL) has been found to reduce the incidence of nonsurgical AF when added to guideline-recommended therapy in patients with systolic heart failure. Based on these findings, we primarily aimed to evaluate by retrospective analysis the impact of the two AAs, EPL and spironolactone (SPL), given at standard therapeutic doses in preventing new-onset POAF in patients the majority of which had a preoperative ejection fraction (EF) below 40%. A total of 332 patients (298 men/34 women, mean age 64.3 ± 9 years) without history of AF were included in this analysis; 132 of these patients received long-term EPL or SPL in addition to beta-blockade/statins therapy and 200 patients received neither EPL nor SPL. All patients underwent on-pump coronary artery bypass graft (80%) and/or valvular surgery (20%). In the nonAA group (EF = 35.8 ± 6%) 90/200 patients (45%) had POAF, while in the AA group (EF = 36.2 ± 5%) only 40/132 patients (30.3%) developed POAF (P < 0.01, χ (2) test). Multivariate logistic regression analysis revealed that only AAs and left atrial diameter significantly affected the development of POAF even when adjusted for other clinical variables (P < 0.05). In conclusion, AAs significantly reduced the incidence of POAF when added to standard heart failure therapy in patients undergoing on-pump cardiac surgery.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa Medical School, University of Thessaly, Larissa, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Simopoulos
authors.forename: G
authors.initials: G
authors.lastname: Tagarakis
authors.forename: A
authors.initials: A
authors.lastname: Hatziefthimiou
authors.forename: I
authors.initials: I
authors.lastname: Skoularigis
authors.forename: F
authors.initials: F
authors.lastname: Triposkiadis
authors.forename: V
authors.initials: V
authors.lastname: Trantou
authors.forename: N
authors.initials: N
authors.lastname: Tsilimingas
authors.forename: I
authors.initials: I
authors.lastname: Aidonidis
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects; D000077545:Eplerenone; D005260:Female; D006115:Greece / Q000453:epidemiology; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006351:Heart Valves / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013148:Spironolactone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone