The HMG-CoA reductase inhibitor atorvastatin prevents atrial fibrillation by inhibiting inflammation in a canine sterile pericarditis model. Atorvastatin prevents atrial fibrillation in patients with bradyarrhythmias and implantation of an atrial-based or dual-chamber pacemaker: a prospective randomized trial. A strategy to achieve CRT response in permanent atrial fibrillation without obligatory atrioventricular node ablation. Mortality After Atrioventricular Nodal Radiofrequency Catheter Ablation With Permanent Ventricular Pacing in Atrial Fibrillation: Outcomes From a Controlled Nonrandomized Study High-sensitivity C-reactive protein, statin therapy, and risks of atrial fibrillation: an exploratory analysis of the JUPITER trial. Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery. Usefulness of statin drugs in protecting against atrial fibrillation in patients with coronary artery disease. Progression to chronic atrial fibrillation after pacing: the Canadian Trial of Physiologic Pacing. CTOPP Investigators. Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Four-year efficacy of cardiac resynchronization therapy on exercise tolerance and disease progression: the importance of performing atrioventricular junction ablation in patients with atrial fibrillation. Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation. Enalapril Decreases the Incidence of Atrial Fibrillation in Patients With Left Ventricular Dysfunction Insight From the Studies Of Left Ventricular Dysfunction (SOLVD) Trials Evaluation of right atrial and biatrial temporary pacing for the prevention of atrial fibrillation after coronary artery bypass surgery. 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. Intravenous Plus Oral Amiodarone, Atrial Septal Pacing, or Both Strategies to Prevent Post-Cardiothoracic Surgery Atrial Fibrillation: The Atrial Fibrillation Suppression Trial II (AFIST II) Acute and long-term effects of atrioventricular junction ablation and VVIR pacemaker in symptomatic patients with chronic lone atrial fibrillation and normal ventricular response.
OBJECTIVE It has been recently reported that AF is associated with tissue inflammation . Statins reduce C-reactive protein ( CRP ) levels . However , the effect of statin on atrial fibrillation ( AF ) is unclear . The purpose of the present study was to evaluate the effect of statin on AF in a canine sterile pericarditis model . METHODS Sterile pericarditis was created in 20 dogs r and omly assigned to two groups : a control group ( 10 dogs ) and an atorvastatin treatment group ( 10 dogs ) . Atorvastatin was administered orally ( 2 mg/kg/day ) beginning 1 week before the operation until the end of the study . Before and 2 days after the operation , CRP levels , the duration of induced AF , the atrial effective refractory period ( AERP ) , and intra-atrial conduction time were determined . RESULTS Before the operation , there were no significant differences in any of the parameters between the two groups . On the second postoperative day , the atorvastatin group had a lower CRP level ( 7.6+/-0.5 versus 11.7+/-1.3 mg/dl , P<0.0001 ) , a shorter AF duration ( 177+/-57 versus 534+/-189 s , P<0.0001 ) , a longer AERP ( 138+/-6 versus 130+/-6 ms , P<0.01 ) , and a shorter intra-atrial conduction time ( 46+/-3 versus 51+/-5 ms , P<0.01 ) than the control group . CONCLUSIONS Atorvastatin can prevent maintenance of AF by inhibiting inflammation in the canine sterile pericarditis model . Atorvastatin may thus be a novel therapeutic agent for AF 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 prospect i ve r and omized design for 1 year of follow-up . RESULTS Fifty-two patients ( 23 males , 70 + /- 13 years old ) were r and omized 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 BACKGROUND Cardiac resynchronization therapy ( CRT ) is an established method in patients with severe heart failure and wide QRS configuration , particularly during sinus rhythm ( SR ) . In CRT patients with permanent atrial fibrillation ( AF ) , there is no general consensus regarding the need for atrioventricular node ( AVN ) ablation . The aim of this study was to evaluate the benefit of CRT in permanent AF with and without AVN ablation . METHODS New York Heart Association classification , QRS duration , and echocardiographic parameters were assessed before and after CRT with a follow-up of 12 ± 3 months . Two hundred thirty patients in SR and 46 patients with permanent AF of 2.1 ± 0.5 years duration were studied .  AVN ablation was performed only in AF patients with insufficient pharmacological rate control evidence d by ≤80 % ventricular stimulation . RESULTS Fifteen AF patients underwent AVN ablation . Biventricular pacing comparably improved functional status , left ventricular ejection fraction , and left ventricular end-diastolic dimensions in all treated groups . Biventricular stimulation percentage was 10 % lower in pharmacologically treated AF patients over 1 year as compared to patients in SR and to AF patients undergoing AVN ablation , which did not affect outcome in this patient population . CONCLUSION In patients with permanent AF and CRT , an AVN ablation strategy might not be strictly required in all patients Background —Atrioventricular nodal radiofrequency ablation ( AVNA ) with permanent ventricular pacing can be used to control rate in patients with atrial fibrillation ( AF ) . However , long-term outcomes after AVNA are uncertain , especially in light of irreversible pacemaker dependence . Methods and Results —We examined 9122 consecutive patients with AF . The outcomes in 453 patients with AVNA ( 26 % of whom underwent an implantable cardiac defibrillator implant and 37 % underwent cardiac resynchronization therapy implant ) were compared with AF patients without AVNA after propensity score 1:1 matching . During follow-up in the propensity-matched cohort ( 2.41±3.23 years , median 1.23 , quartiles 0.33–3.12 ) , 100 patients died ( yearly rate of death 6.6 % ) . Mode of death was available in 86 % of patients , which was cardiovascular in 67 % of the patients ( related to heart failure in 38 % , sudden death in 5 % , and other cardiovascular reason in 24 % ) and noncardiovascular in 33 % . AVNA in patients with AF was associated with a lower risk of mortality ( odds ratio 0.47 , 95 % confidence interval , 0.29–0.77 ; P=0.003 ) , a lower risk of cardiovascular mortality ( odds ratio = 0.41 , 95 % confidence interval 0.23–0.73 ; P=0.003 ) , and nonsignificant lower risk of stroke and thromboembolic events ( odds ratio = 0.61 , 95 % confidence interval 0.36–1.06 ; P=0.08 ) . Conclusions —In sick AF patients with multiple comorbidities  , AVNA with permanent ventricular pacing for rate control seems safe during follow-up and may be associated with lower mortality AIMS Increasing evidence supports a role for inflammation in promoting  atrial fibrillation ( AF ) and statins have anti-inflammatory effects that may be relevant for the prevention of AF . However , studies of statin therapy and incident AF have yielded mixed results and not focused on individuals with an underlying pro-inflammatory response . We studied whether high-sensitivity C-reactive protein is associated with incident AF and whether treatment with rosuvastatin is associated with a lower incidence of AF compared with placebo . METHODS AND RESULTS We r and omized men and women with LDL cholesterol < 130 mg/dL and high-sensitivity C-reactive protein ≥2 mg/L to receive either rosuvastatin 20 mg daily or placebo .  Atrial fibrillation was determined from treatment-blind adverse event reports . Among 17 120 participants without prior history of arrhythmia , each increasing tertile of baseline high-sensitivity C-reactive protein was associated with a 36 % increase in the risk of developing AF ( 95 % CI : 1.16 - 1.60 ; P-trend < 0.01 ) . Allocation to rosuvastatin when compared with placebo was associated with a 27 % reduction in the relative risk of developing AF during the trial period ; specifically , AF was reported among 138 participants in the placebo group and 100 in the rosuvastatin group ( incidence rate 0.78 vs. 0.56/100 person-years , HR : 0.73 , 95 % CI : 0.56 - 0.94 , P = 0.01 ) . The exclusion of participants who developed a major cardiovascular event prior to the report of AF yielded similar results . CONCLUSION Within the JUPITER trial cohort of individuals selected for underlying inflammation , increasing levels of high-sensitivity C-reactive protein were associated with an increased risk of incident AF and r and om allocation to rosuvastatin significantly reduced that risk OBJECTIVES The present study was aim ed to evaluate the efficacy of a specific algorithm with continuous atrial dynamic overdrive pacing to prevent atrial fibrillation ( AF ) after coronary artery bypass graft ( CABG ) surgery . BACKGROUND Atrial fibrillation occurs in 30 % to 40 % of patients after cardiac surgery with a peak incidence on the second day . It still represents a challenge for postoperative prevention and treatment and may have medical and cost implication s. METHODS Ninety-six consecutive patients undergoing CABG for severe coronary artery disease and in sinus rhythm without antiarrhythmic therapy on the second postoperative day were r and omized to have or not 24 h of atrial pacing through temporary epicardial wires using a permanent dynamic overdrive algorithm .  Holter ECGs recorded the same day in both groups were analyzed to detect AF occurrence . RESULTS No difference was observed in baseline data between the two study groups , particularly for age , male gender , history of AF , ventricular function , severity of coronary artery disease , preoperative beta-adrenergic blocking agent therapy or P-wave duration . The incidence of AF was significantly lower ( p = 0.036 ) in the paced group ( 10 % ) compared with control subjects ( 27 % ) . Multivariate analysis showed AF incidence to increase with age ( p = 0.051 ) but not in patients with pacing ( p = 0.078 ) . It decreased with a better left ventricular ejection fraction only in conjunction with atrial pacing ( p = 0.018 ) . CONCLUSIONS We conclude that continuous atrial pacing with an algorithm for dynamic overdrive reduces significantly incidence of AF the second day after CABG surgery , particularly in patients with preserved left ventricular function 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 OBJECTIVES This study examined the effect of physiologic pacing on the development of  chronic atrial fibrillation ( CAF ) in the Canadian Trial Of Physiologic Pacing ( CTOPP ) . BACKGROUND The role of physiologic pacing to prevent CAF remains unclear . Small r and omized studies have suggested a benefit for patients with sick sinus syndrome . No data from a large r and omized trial are available . METHODS The CTOPP r and omized patients undergoing first pacemaker implant to ventricular-based or physiologic pacing ( AAI or DDD ) . Patients who were prospect ively found to have persistent atrial fibrillation ( AF ) lasting greater than or equal to one week were defined as having CAF . Kaplan-Meier plots for the development of CAF were compared by log-rank test . The effect of baseline variables on the benefit of physiologic pacing was evaluated by Cox proportional hazards modeling . RESULTS Physiologic pacing reduced the development of CAF by 27.1 % , from 3.84 % per year to 2.8 % per year ( p = 0.016 ) . Three clinical factors predicted the development of CAF : age > or = 74 years ( p = 0.057 ) , sinoatrial ( SA ) node disease ( p < 0.001 ) and prior AF ( p < 0.001 ) . Subgroup analysis demonstrated a trend for patients with no history of myocardial infa rct ion or coronary disease ( p = 0.09 ) as well as apparently normal left ventricular function ( p = 0.11 ) to derive greatest benefit . CONCLUSIONS Physiologic pacing reduces the annual rate of development of chronic AF in patients undergoing first pacemaker implant . Age > or = 74 years , SA node disease and prior AF predicted the development of CAF . Patients with structurally normal hearts appear to derive greatest benefits The Canadian Cardiovascular Society ( CCS ) published the complete set of 2010 Atrial Fibrillation ( AF ) Guidelines in the January , 2011 issue of the Canadian Journal of Cardiology . During its deliberations , the CCS Guidelines Committee engaged to a timely review of future evidence , with periodic composition of focused up date s to address clinical ly important advances . In 2011 , results were published from 3 pivotal AF trials : the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonist for Prevention of Stroke and Embolism Trial in Atrial Fibrillation ( ROCKET-AF ) , the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation ( ARISTOTLE ) study , and the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of St and ard Therapy ( PALLAS ) , comparing dronedarone with placebo in patients with permanent AF and additional cardiovascular disease risk-factor burden . Each of these large r and omized trials provided clear results with major implication s for AF management . Other important evidence that has emerged since the 2010 Guidelines includes findings about prediction instruments for AF-associated stroke and bleeding risk , stroke risk in paroxysmal-AF patients , risk-benefit considerations related to oral anticoagulation in patients with chronic kidney disease , and risk/benefit considerations in the use of antiplatelet agents , alone and in combination with each other or with oral anticoagulants , in AF patients . The Guidelines Committee judged that this extensive and important new evidence required focused updating of the 2010 Guidelines with respect to stroke prevention and rate/rhythm control . This report presents the details of the new recommendations , along with the background and rationale OBJECTIVES The goal of this study was to investigate the effects of cardiac resynchronization therapy ( CRT ) in heart failure patients with permanent atrial fibrillation ( AF ) and the role of atrioventricular junction ( AVJ ) ablation . BACKGROUND Cardiac resynchronization therapy has been proven effective in heart failure patients with sinus rhythm ( SR ) . However , little is known about the effects of CRT in heart failure patients with permanent AF . METHODS Efficacy of CRT on ventricular function , exercise performance , and reversal of maladaptive remodeling process was prospect ively compared in 48 patients with permanent AF in whom ventricular rate was controlled by drugs , thus result ing in apparently adequate delivery of biventricular pacing ( > 85 % of pacing time ) , and in 114 permanent AF patients , who had undergone AVJ ablation ( 100 % of resynchronization therapy delivery ) . The clinical and echocardiographic long-term outcomes of both groups were compared with those of 511 SR patients treated with CRT . RESULTS Both SR and AF groups showed significant and sustained improvements of all assessed parameters ( model p < 0.001 for all parameters ) . However , within the AF group , only patients who underwent ablation showed a significant increase of ejection fraction ( p < 0.001 ) , reverse remodeling effect ( p < 0.001 ) , and improved exercise tolerance ( p < 0.001 ) ; no improvements were observed in AF patients who did not undergo ablation . CONCLUSIONS Heart failure patients with ventricular conduction disturbance and permanent AF treated with CRT showed large and sustained long-term ( up to 4 year ) improvements of left ventricular function and functional capacity , similar to patients in SR , only if AVJ ablation was performed OBJECTIVES The aim of this study was to determine the independent hemodynamic effects of an irregular sequence of ventricular cycle lengths in patients with atrial fibrillation ( AF ) . BACKGROUND Atrial fibrillation may reduce cardiac output by several possible mechanisms , including loss of the atrial contribution to left ventricular filling , valvular regurgitation , increased ventricular rate or irregular RR intervals . This study was design ed to evaluate the effects of an irregular RR interval , independent of the average ventricular rate , on cardiac hemodynamic data during AF . METHODS Sixteen patients with AF were studied invasively . During intrinsically conducted AF ( mean rate 102 + /- 22 beats/ min ) , the right ventricular apex electrogram was recorded onto frequency-modulated ( FM ) tape . After atrioventricular node ablation , the right ventricular apex was stimulated in three pacing modes in r and omized sequence : 1 ) VVI at 60 beats/min ; 2 ) VVI at the same average rate as during intrinsically conducted AF ( 102 + /- 22 beats/min ) ; and 3 ) during VVT pacing in which the pacemaker was triggered by playback of the FM tape recording of the right ventricular apex electrogram previously recorded during intrinsically conducted AF ( VVT 102 + /- 22 beats/min ) . RESULTS Compared with VVI pacing at the same average rate , an irregular sequence of RR intervals decreased cardiac output ( 4.4 + /- 1.6 vs. 5.2 + /- 2.4 liters/min , p < 0.01 ) , increased pulmonary capillary wedge pressure ( 17 + /- 7 vs. 14 + /- 6 mm Hg , p < 0.002 ) and increased right atrial pressure ( 10 + /- 6 vs. 8 + /- 4 mm Hg , p < 0.05 ) . CONCLUSIONS An irregular sequence of RR intervals produces adverse hemodynamic consequences that are independent of heart rate Background Atrial fibrillation ( AF ) is frequently encountered in patients with heart failure ( HF ) and is also a predictor of morbidity and mortality in this population . Recent experimental studies have shown electrical and structural atrial remodeling with increased fibrosis in animals with HF and have suggested a preventive effect of ACE inhibitors ( ACEi ) on the development of AF . To verify the hypothesis that ACEi prevent the development of AF in patients with HF , we conducted a retrospective analysis of the patients from the Montreal Heart Institute ( MHI ) included in the Studies Of Left Ventricular Dysfunction ( SOLVD ) . Methods and Results Clinical charts were review ed and serial ECGs interpreted by a single cardiologist blinded to drug allocation . Patients with AF or flutter on the baseline ECG were excluded . Baseline characteristics were obtained from the SOLVD data bases . The mean follow‐up was 2.9±1.0 years . Of the 391 patients r and omly assigned at MHI , 374 were in sinus rhythm at the time of r and om assignment , with 186 taking enalapril and 188 taking placebo .  Baseline characteristics were similar in the two groups except for a higher incidence of previous myocardial infa rct ion in the enalapril group . Fifty‐five patients had AF during the follow‐up : 10 ( 5.4 % ) in the enalapril group and 45 ( 24 % ) in the placebo group ( P<0.0001 ) . By Cox multivariate analysis , enalapril was the most powerful predictor for risk reduction of AF ( hazard ratio , 0.22 ; 95 % CI , 0.11 to 0.44 ; P<0.0001 ) . Conclusions Treatment with the ACEi enalapril markedly reduces the risk of development of atrial fibrillation in patients with left ventricular dysfunction . ( Circulation . 2003;107:2926‐2931 . OBJECTIVES The purpose of this study was to determine if atrial pacing is effective in reducing  postoperative atrial fibrillation ( AF ) .  BACKGROUND Atrial fibrillation after coronary artery bypass grafting ( CABG ) is a common problem for which medical management has been disappointing . Atrial-based pacing has become an attractive nonpharmacologic therapy for the prevention of AF . METHODS Sixty-one post-CABG patients ( mean age = 65 years ) were r and omized to one of three groups : no atrial pacing ( NAP ) , right atrial pacing ( RAP ) or biatrial pacing ( BAP ) . Each patient had one set of atrial wires attached to both the right and left atria , respectively , at the conclusion of surgery . Patients in the RAP and BAP groups were continuously paced at a rate of 100 pulses per minute for 96 h or until the onset of sustained AF ( > 10 min ) . All patients were monitored with Holter monitors or full disclosure telemetry to identify the onset of AF . The primary end point of the study was the first onset of sustained AF . RESULTS There was no significant difference in the proportion of patients developing AF in the three groups ( NAP = 33 % ; RAP = 29 % ; BAP = 37 % ; p > 0.7 ) . However , for the subset of patients on beta-adrenergic blocking agents after CABG , there was a trend toward less AF in the paced groups . There were no serious complications related to pacing , although in three patients the pacemaker appeared to induce AF by pacing during atrial repolarization . CONCLUSIONS Continuous right or biatrial pacing in the postoperative setting is safe and well tolerated . We did not find that post-CABG pacing prevented AF in this pilot study ; however , the role of combined pacing and beta-blockade merits further study 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 —The effect of a hybrid intravenous and oral prophylactic amiodarone regimen on postcardiothoracic surgery ( CTS ) atrial fibrillation ( AF )  is unknown . The impact of active atrial septal pacing on post-CTS AF has not been well characterized . In addition , the effect of using both amiodarone and atrial septal pacing together to prevent atrial fibrillation is unknown . Methods and Results — Patients ( n=160 ) were r and omized to amiodarone or placebo and then to pacing or no pacing using a 2 × 2 factorial design . All therapies began within 6 hours post-CTS . Amiodarone was given by intravenous infusion for the first 24 hours ( 1050 mg total ) followed by oral therapy for 4 postoperative days ( 4800 mg total ) . Atrial septal pacing was given for 96 hours . Amiodarone  reduced the risk of AF by 43 % and the risk of symptomatic AF by 68 % ( P = 0.037 and P = 0.019 ) versus placebo . Atrial septal pacing did not reduce AF or symptomatic AF incidence versus no pacing . The risk of post-CTS AF in the patients receiving amiodarone+pacing was lower than the placebo+no pacing and the placebo+pacing groups ( 57.9 % and 60.5 % reductions , P = 0.047 and P = 0.040 , respectively ) . Conclusions —Amiodarone given as both an intravenous and oral regimen is effective at reducing post-CTS AF but atrial septal pacing is ineffective . Combining amiodarone and pacing is better than placebo with or without pacing but not amiodarone alone INTRODUCTION The precise role of irregular ventricular response in atrial fibrillation ( AF ) has not been fully eluci date d. This study examined the independent effects of rhythm regularity in patients with chronic AF . METHODS AND RESULTS This study included 50 patients who had chronic lone AF and a normal ventricular rate . Among these patients , 21 who underwent AV junction ablation and implantation of a VVIR pacemaker constituted the ablation group ; the other 29 patients were the medical group .  Acute hemodynamic findings were measured in 21 ablation patients before ablation ( during AF , baseline ) and 15 minutes after ablation ( during right ventricular pacing ) . Compared with baseline data , ablation and pacing therapy increased cardiac output ( 4.7 + /- 0.8 vs 5.2 + /- 0.9 L/min ; P = 0.05 ) , decreased pulmonary capillary wedge pressure ( 16 + /- 5 vs 13 + /- 4 mmHg ; P = 0.001 ) , and decreased left ventricular end-diastolic pressure ( 14 + /- 4 vs 11 + /- 3 mmHg ; P < 0.05 ) . After 12 months , the ablation group patients showed lower scores in general quality of life ( -20 % ; P < 0.001 ) , overall symptoms ( -24 % ; P < 0.001 ) , overall activity scale ( -23 % ; P = 0.004 ) , and significant increase of left ventricular ejection fraction ( 44 % + /- 6 % vs 49 % + /- 5 % ; P = 0.02 ) by echocardiographic examination . CONCLUSION AV junction ablation and pacing in patients with chronic AF and normal ventricular response may confer acute and long-term benefits beyond rate control by eliminating rhythm irregularity
Statistical heterogeneity between included studies was not detected ( chi(2 ) = 1.68 , P = 0.43 , I(2 ) = 0 % ) , although significant clinical differences were found in terms of study design , patient population s , statins use and dosage and AF-monitoring capabilities .
Statins may represent a novel treatment strategy to prevent the occurrence of AF in patients with PM , especially for those who had a PM implanted due to sinus node dysfunction .
Patients with permanent pacemakers ( PM ) are at high risk of developing atrial fibrillation ( AF ) .
Minimal ventricular pacing modalities have been demonstrated to reduce AF in such patients , although they are not suitable for patients with advanced atrioventricular conduction disease .
Recent evidence s suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors ( i.e. statins ) may represent a new strategy to prevent AF in patients at risk .
In this article , we sought to review data regarding the effectiveness of statin therapy in preventing AF patients with a PM .