Effect of statin dose on incidence of atrial fibrillation: data from the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) and Aggrastat to Zocor (A to Z) trials. Atorvastatin for prevention of atrial fibrillation recurrence following pulmonary vein isolation: a double-blind, placebo-controlled, randomized trial. The effects of statins and renin-angiotensin system blockers on atrial fibrillation recurrence following antral pulmonary vein isolation. Usefulness of statin drugs in protecting against atrial fibrillation in patients with coronary artery disease. Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery. Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care. Randomized Trial of Atorvastatin for Reduction of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: Results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) Study Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting. Patients with Stable Coronary Artery Disease Receiving Chronic Statin Treatment Who Are Undergoing Noncardiac Emergency Surgery Benefit from Acute Atorvastatin Reload
BACKGROUND Inflammation has been suggested as a factor in the initiation and maintenance of  atrial fibrillation ( AF ) . Several observational studies have suggested that statins , presumably through their anti-inflammatory properties , decrease the risk of AF . METHODS We analyzed 2 large , r and omized trials , PROVE IT-TIMI 22 and phase Z of the A to Z trial , which compared lower- versus higher-intensity statin therapy to evaluate whether higher-intensity statin therapy lowered the risk of AF onset during the 2 years of follow-up . We hypothesized that higher-intensity statin therapy would decrease the risk of AF when compared to lower-intensity statin therapy . From each trial , patients experiencing the onset of AF during follow-up were identified from the adverse event reports . RESULTS Neither study showed a decreased AF risk with higher-dose statin . In PROVE IT-TIMI 22 , 2.9 % versus 3.3 % in the high- versus st and ard-dose statin therapy , respectively , experienced the onset of AF over 2 years ( OR 0.86 , 95 % CI 0.61 - 1.23 , P = .41 ) . In A to Z , rates were 1.6 % versus 0.99 % , respectively ( OR 1.58 , 95 % CI 0.92 - 2.70 , P = .096 ) . In both trials , C-reactive protein levels ( plasma or serum ) tended to be higher among patients experiencing the onset of AF . CONCLUSION Our r and omized comparison among 8659 patients found that higher-dose statin therapy did not reduce the short term incidence of AF among patients after acute coronary syndromes when compared with st and ard dose statin treatment BACKGROUND It is known that statins are effective in preventing atrial fibrillation ( AF ) in patients undergoing cardiac surgery . OBJECTIVE The purpose of this study was to evaluate the efficacy of statins in preventing AF recurrence following left atrial ablation . METHODS One hundred twenty-five patients who had no statin indication undergoing catheter ablation due to drug-refractory paroxysmal ( n = 90 ) or persistent ( n = 35 ) AF were r and omized in a prospect i ve , double-blind , placebo-controlled trial to receive 80 mg atorvastatin ( n = 62 ) or placebo ( n = 63 ) for 3 months . The primary endpoint was freedom from symptomatic AF at 3 months . Secondary endpoints included freedom from any atrial arrhythmia recurrence irrespective of symptoms , quality of life ( QoL ) , and reduction in C-reactive protein ( CRP ) . RESULTS At 3 months , 95 % of patients in the atorvastatin group were free of symptomatic AF compared with 93.5 % in the placebo group ( P = .75 ) . Similarly , 85 % of patients treated in the atorvastatin group remained free of any recurrent atrial arrhythmia vs 88 % of patients in the placebo group ( P = .37 ) . Mean CRP levels decreased in the atorvastatin group ( mean change -0.75 ± 3 , P = .02 ) and increased in the placebo group ( mean change 2.1 ± 19.9 , P = .48 ) . Mean QoL score improved significantly in both groups ( mean change 13.14 ± 18.2 in the atorvastatin group and 11.10 ± 17.7 in the placebo group , P = .53 ) . CONCLUSION In patients with no st and ard indication for statin therapy  , treatment with atorvastatin 80 mg/day following AF ablation does not decrease the risk of AF recurrence in the first 3 months and should not be routinely administered to prevent periprocedural arrhythmias INTRODUCTION Ablation has emerged as a major treatment option for atrial fibrillation ( AF ) . However , this procedure is limited by a significant rate of AF recurrence . We aim ed to examine the effects of statins , angiotensin-converting enzyme inhibitors ( ACE-I ) , and angiotensin receptor blockers ( ARB ) on the recurrence rate of AF following ablation . METHODS We conducted a retrospective study of 177 consecutive patients ( mean age = 56 + /- 11 yrs , 69 % males ) who underwent ablation for paroxysmal ( n = 132 ) or persistent AF ( n = 45 ) . Patients were treated with ACE-I ( n = 31 ) or ARB ( n = 18 ) or statins ( n = 50 ) prior to ablation and for the duration of follow-up . RESULTS After a mean follow-up of 13.8 + /- 8.6 months , 72 % of patients were free of AF . For patients taking statins , 33 of 50 ( 60 % ) were free of AF . In patients treated with ACE-I , 17 of 31 ( 55 % ) were free from AF , while in the group of patients treated with ARB , 17 of 18 ( 94 % ) were free from AF . Using Cox regression analysis to correct for baseline variables , treatment with statins did not decrease the recurrence rate ( HR = 1.10 [ 95 % CI : 0.55 - 2.27 ] p = 0.79 ) ; nor did treatment with renin angiotensin system ( RAS ) blockers ( HR 0.94 [ 95 % CI : 0.46 - 1.93 ] p = 0.87 ) . However , subgroup analysis showed that treatment with ARB was associated with a trend towards lower AF recurrence [ HR 0.17 , ( 95 % CI : 0.02 - 1.34 ) p = 0.09 ] . CONCLUSIONS Even though statins and RAS blockers possess anti-inflammatory properties , they did not decrease the recurrence of AF following ablation . However , the subset of patients taking ARB exhibited a trend towards lower AF recurrence . Larger , r and omized studies are needed to address this observation Atrial  fibrillation ( AF ) is prevalent in the elderly , in patients with hypertension , and in patients with coronary artery disease ( CAD ) . We hypothesized that statin therapy might be effective in preventing AF in patients with CAD and examined this hypothesis in a sample of patients with chronic stable CAD without AF , followed prospect ively at a large outpatient cardiology practice . The association between statin use and the risk of developing AF was examined univariately and then with adjustment for potential confounding factors . Four hundred forty-nine men and women between the ages of 40 and 87 years were followed for an average of 5 years . Fifty-two patients ( 12 % ) developed AF during follow-up . Statin therapy was used by 59 % of the patients during the study period and was associated with a significantly reduced risk of developing AF ( crude odds ratio , 0.48 , 95 % confidence interval 0.28 to 0.83 ) . This association remained significant after adjustment for potential confounders , including age , hypertension , left ventricular systolic function , occurrence of heart failure or acute ischemic events , and baseline cholesterol and changes in cholesterol levels ( adjusted odds ratio 0.37 , 95 % confidence interval 0.18 to 0.76 ) . Use of  statins in patients with chronic stable CAD appears to be protective against AF . The underlying mechanism for this effect is unknown but appears to be independent of the reduction in serum cholesterol levels Ablation outcomes were investigated in patients with and without statin pretreatment before cardiac surgery with concomitant surgical ablation for atrial fibrillation ( AF ) . A prospect i ve cohort study was performed containing 149 patients ( n=73 statin group vs. n=76 control group ) undergoing on-pump cardiac procedures with surgical ablation for paroxysmal or persistent AF . Measured outcomes were freedom from AF in the intensive care unit , discharge and at three and six months follow-up and perioperative markers of inflammation ( white blood cell count , C-reactive protein ) . Independent predictors for freedom from AF were assessed . Groups did not differ with respect to EuroSCORE , New York Heart Association class , left atrial size , anti-arrhythmic drug therapy or aortic cross-clamp time . Statin therapy had no impact on postoperative inflammatory markers . Freedom from AF was more frequent in the statin group at discharge ( P=0.07 ) and after three and six months ( P<0.05 ) . Subgroup analysis showed that statin pretreatment was associated with higher rates of freedom from AF for paroxysmal AF at three and six months and for persistent AF after six months ( P<0.05 ) . Importantly , statin-pretreatment was independently predictive for freedom from AF at discharge [ odds ratio ( OR ) : 3.21 ; 95 % confidence interval ( CI ) : 1.2 - 8.55 ; P=0.02 ] and at three months ( OR : 2.91 ; 95 % CI : 1.14 - 7.45 ; P=0.026 ) . Statin therapy prior to ablation surgery improves postoperative freedom from AF for paroxysmal and persistent AF in cardiac surgery patients OBJECTIVES The present study determined the incidence and time course of atrial fibrillation ( AF ) recurrences  in patients with a history of AF and fitted with an implantable monitoring device .  BACKGROUND The long-term risk of undetected recurrence of AF in patients receiving stable antiarrhythmic therapy remains uncertain . METHODS In 110 patients with a class I indication for physiologic pacing and a history of AF , a pacemaker with dedicated functions for AF detection and electrogram storage was implanted , and antiarrhythmic drug treatment was optimized . Patients were regularly followed up with evaluation of AF-related symptoms , a  resting electrocardiogram ( ECG ) , and  interrogation of device memory .  The incidence of AF recurrences lasting > 48 h in asymptomatic patients presenting in sinus rhythm ( SR ) at the respective follow-up visit constituted the primary end point of this prospect i ve study . RESULTS During 19 + /- 11 months , 678 follow-up visits were performed . Atrial fibrillation was documented in 51 patients ( 46 % ) by ECG recording and in 97 patients ( 88 % ) by a review of stored electrograms ( p < 0.0001 ) . Device interrogation revealed AF recurrences lasting > 48 h in 50 patients , 19 of whom ( 38 % ) were completely asymptomatic and in SR at subsequent follow-up . In 11 ( 16 % ) of 67 patients with device-confirmed freedom from AF for > or =3 months , AF lasting > 48 h recurred subsequently . CONCLUSIONS This prospect i ve study demonstrates a high incidence of recurrent AF despite optimized antiarrhythmic therapy . Of particular note , AF relapses > 48 h remained totally asymptomatic in a significant proportion of patients . Freedom from AF for > or =3 months did not preclude subsequent long-lasting AF recurrence Background — Atrial fibrillation ( AF ) after cardiac surgery is associated with increased risk of complications , length of stay , and cost of care . Observational evidence suggests that patients who have undergone previous statin therapy have a lower incidence of postoperative AF . We tested this observation in a r and omized , controlled trial . Methods and Results — Two hundred patients undergoing elective cardiac surgery with cardiopulmonary bypass , without previous statin treatment or history of AF , were enrolled . Patients were r and omized to atorvastatin ( 40 mg/d , n=101 ) or placebo  ( n=99 ) starting 7 days before operation . The primary end point was incidence of postoperative AF ; secondary end points were length of stay , 30-day major adverse cardiac and cerebrovascular events , and postoperative C-reactive protein ( CRP ) variations . Atorvastatin significantly reduced the incidence of AF versus placebo ( 35 % versus 57 % , P=0.003 ) . Accordingly , length of stay was longer in the placebo versus atorvastatin arm ( 6.9±1.4 versus 6.3±1.2 days , P=0.001 ) . Peak CRP levels were lower in patients without AF ( P=0.01 ) , irrespective of r and omization assignment . Multivariable analysis showed that atorvastatin treatment conferred a 61 % reduction in risk of AF ( odds ratio 0.39 , 95 % confidence interval 0.18 to 0.85 , P=0.017 ) , whereas high postoperative CRP levels were associated with increased risk ( odds ratio 2.0 , 95 % confidence interval 1.2 to 7.0 , P=0.01 ) . The incidence of major adverse cardiac and cerebrovascular events at 30 days was similar in the 2 arms . Conclusions — Treatment with atorvastatin 40 mg/d , initiated 7 days before surgery , significantly reduces the incidence of postoperative AF after elective cardiac surgery with cardiopulmonary bypass and shortens hospital stay . These results may influence practice patterns with regard to adjuvant pharmacological therapy before cardiac surgery Atrial fibrillation ( AF ) is one of the most common postoperative arrhythmias in patients who undergo coronary artery bypass grafting ( CABG ) . The aim of this study was to evaluate the effect of preoperative atorvastatin on postoperative atrial fibrillation  following coronary artery bypass grafting with cardiopulmonary bypass ( CCABG ) . One hundred consecutive patients undergoing elective CCABG , without history of AF or previous statin treatment , were enrolled and r and omly assigned to a statin group ( atorvastatin 20 mg/d , n = 49 ) or a control group ( placebo , n = 51 ) starting 7 days preoperatively . The primary endpoint was the occurrence of postoperative AF . C-reactive protein ( CRP ) levels were assessed in all selected patients before surgery and every 24 hours postoperatively until discharge from hospital . Atorvastatin significantly reduced the incidence of postoperative AF and postoperative peak CRP level versus placebo ( 18 % versus 41 % , P = 0.017 ; 129.3 ± 24.3 mg/L versus 149.3 ± 32.5 mg/L , P < 0.0001 ) . Kaplan-Meier curves confirmed a significantly better postoperative atrial fibrillation-free survival in the statin group ( χ(2 ) = 7.466 , P = 0.006 ) . Logistic regression analysis showed preoperative atorvastatin treatment was an independent factor associated with a significant reduction in postoperative AF ( OR = 0.235 , P = 0.007 ) , whereas high postoperative CRP levels were associated with increased risk ( OR = 2.421 , P = 0.015 ) . Preoperative atorvastatin administration may inhibit inflammatory reactions to prevent atrial fibrillation following coronary artery bypass grafting with cardiopulmonary bypass Objective : This study was design ed to investigate whether patients with stable coronary artery disease ( CAD ) receiving chronic statin treatment who are undergoing noncardiac emergency surgery benefit from acute atorvastatin reload . Methods : A total of 500 patients with stable CAD and regular administration of statin before noncardiac emergency surgery were r and omized to atorvastatin reload ( n = 250 ) or placebo ( n = 250 ) . All patients received atorvastatin treatment thereafter . The primary end point was a 30-day incidence of major adverse cardiac events ( MACE ) . Secondary end points were the incidence of atrial fibrillation ( AF ) during hospitalization and length of hospital stay . Results : The primary end point occurred in 2.4 % of patients treated with atorvastatin reload and in 8 % in the placebo arm ( p = 0.0088 ) . The incidence of AF during hospitalization was 6.8 % in patients treated with atorvastatin reload and 17 % in the placebo arm ( p = 0.0003 ) . Compared with the placebo arm , the atorvastatin reload arm shortened the length of stay ( 9.8 ± 3.3 vs. 10.6 ± 3.5 days , p = 0.009 ) . Multivariable analysis suggested that atorvastatin reload conferred a 65 % risk reduction of 30-day MACE ( odds ratio 0.35 , 95 % confidence interval 0.18 - 0.86 ; p = 0.005 ) . Conclusion : The trial suggests that atorvastatin reload may improve the clinical outcome of patients with stable CAD receiving chronic statin treatment who are undergoing noncardiac emergency surgery
Use of statins was significantly associated with a decreased risk of incidence or recurrence of AF in patients in sinus rhythm with a history of previous AF or undergoing cardiac surgery or after acute coronary syndrome
OBJECTIVES To improve the evaluation of the possible antiarrhythmic effect of statins , we performed a meta- analysis of r and omized trials with statins on the end point of incidence or recurrence of atrial fibrillation ( AF ) .
BACKGROUND The use of statins had been suggested to protect against AF in some clinical observational and experimental studies but has remained inadequately explored .