Statin for prevention of atrial fibrillation after off-pump coronary artery bypass grafting in Japanese patients. Atorvastatin for prevention of atrial fibrillation recurrence following pulmonary vein isolation: a double-blind, placebo-controlled, randomized trial. Preoperative high-dose atorvastatin for prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. Preoperative statins for the prevention of atrial fibrillation after cardiothoracic surgery. The HMG-CoA reductase inhibitor atorvastatin prevents atrial fibrillation by inhibiting inflammation in a canine sterile pericarditis model. Analysis of pravastatin to prevent recurrence of atrial fibrillation after electrical cardioversion. Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting. Usefulness of statin drugs in protecting against atrial fibrillation in patients with coronary artery disease. Atorvastatin prevents atrial fibrillation in patients with bradyarrhythmias and implantation of an atrial-based or dual-chamber pacemaker: a prospective randomized trial. A community survey of patients with atrial fibrillation: associated disabilities and treatment preferences. Risk factors for stroke in patients with nonrheumatic atrial fibrillation: a case-control study. Efficacy of Combination Therapy of Statin and Vitamin C in Comparison with Statin in the Prevention of Post-CABG Atrial Fibrillation. Atrial fibrillation: the rate versus rhythm management controversy. Should Stroke Subtype Influence Anticoagulation Decisions to Prevent Recurrence in Stroke Patients With Atrial Fibrillation? High-sensitivity C-reactive protein, statin therapy, and risks of atrial fibrillation: an exploratory analysis of the JUPITER trial. Long-term prevention of atrial fibrillation after coronary artery surgery. Comparison of effectiveness of carvedilol versus metoprolol or atenolol for atrial fibrillation appearing after coronary artery bypass grafting or cardiac valve operation. Statin therapy for the prevention of atrial fibrillation trial (SToP AF trial). Use of Scandinavian Moist Smokeless Tobacco (Snus) and the Risk of Atrial Fibrillation Atrial Fibrillation Following Out-of-Hospital Cardiac Arrest and Targeted Temperature Management—Are We Giving It the Attention it Deserves?* Prophylactic oral amiodarone compared with placebo for prevention of atrial fibrillation after coronary artery bypass surgery. Myocardial redox state predicts in-hospital clinical outcome after cardiac surgery effects of short-term pre-operative statin treatment. Amiodarone versus propafenone for conversion of chronic atrial fibrillation: results of a randomized, controlled study. Advanced Age, Anticoagulation Intensity, and Risk for Intracranial Hemorrhage among Patients Taking Warfarin for Atrial Fibrillation Efficacy and proarrhythmic hazards of pharmacologic cardioversion of atrial fibrillation: prospective comparison of sotalol versus quinidine. Maintenance of sinus rhythm after electrical cardioversion of persistent atrial fibrillation; sotalol vs bisoprolol. Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery. Factors relevant to preventing embolic stroke in patients with non-rheumatic atrial fibrillation. Predictors, prevention, and long-term prognosis of atrial fibrillation after coronary artery bypass graft operations. Effects of biatrial pacing in prevention of postoperative atrial fibrillation after coronary artery bypass surgery.
BACKGROUND The purpose of the present study was to assess the preventive effect of preoperative statin treatment on  atrial fibrillation ( AF ) after elective isolated off-pump coronary artery bypass grafting ( off-pump CABG ) in propensity score-matched Japanese patients . METHODS AND RESULTS Among 770 consecutive patients undergoing isolated CABG by the same surgeon ( 99.2 % with off-pump technique without conversion to cardiopulmonary bypass ) between 2002 and 2009 , after excluding emergency ( n=150 ) , chronic AF ( n=30 ) , and use of cardiopulmonary bypass ( n=6 ) , 584 patients were retrospectively review ed . Of this cohort , 364 patients received statin  at least 5 days before operation and 220 patients received no statin . We identified 195 propensity score-matched pairs . Propensity scores were created based on 8 preoperative factors ( C statistics , 0.69 ) . There was no significant difference between the 2 groups in baseline characteristics , perioperative medications , or operative procedures . AF occurred in 14.4 % in the statin group and in 24.6 % in the no statin group ( P=0.01 ) . Multivariate logistic regression including potential univariate predictors identified statin ( odds ratio [ OR ] = 0.49 ; 95 % confidence interval [ 95%CI ] = 0.22 - 0.81 ; P=0.01 ) , age ( OR = 1.33 per 10-year increase ; 95%CI = 1.04 - 1.69 ; P=0.02 ) , and transfusion ( OR = 2.21 ; 95%CI = 1.38 - 3.55 ; P=0.01 ) as independent predictors of postoperative AF . CONCLUSIONS Preoperative statin significantly reduces the incidence of AF after elective isolated off-pump CABG in Japanese patients 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 OBJECTIVE The preventative effect of statins on  postoperative atrial fibrillation  has been hypothesized . However , all studies to date have examined patients who did not receive statins  before their further allocation to treatment or no treatment . Because guidelines recommend the routine use of statins in patients with coronary artery disease , we set out to examine the effect of intensive statin pretreatment versus continuation of usual statin dose on atrial fibrillation after cardiac surgery . METHODS Patients receiving routine statin treatment and undergoing coronary artery bypass surgery or aortic valve replacement with no history of atrial fibrillation or antiarrhythmic medication were r and omized to receive atorvastatin 80 mg or atorvastatin 10 mg for 7 days before surgery in a single-blind fashion . The primary end point was the development of postoperative atrial fibrillation during hospital stay . RESULTS A total of 104 consecutive patients were included . Postoperative atrial fibrillation occurred in 33 patients ( 32.4 % ) . No significant differences were found in demographics , medical history , or intraoperative variables between treatment groups , with the exception of higher rate of β-blocker use in the atorvastatin 10 mg group ( 75 % vs 53 % , P = .002 ) and previous myocardial infa rct ion ( 62 % vs 42 % , P = .049 ) . The incidence of postoperative atrial fibrillation was lower in the atorvastatin 80 mg group when compared with the atorvastatin 10 mg group , but this difference did not reach statistical significance ( 29 % vs 36 % , P = .43 ) . CONCLUSIONS High-dose atorvastatin for 7 days before cardiac surgery conferred a nonsignificant reduction in postoperative atrial fibrillation when compared with a low-dose regimen . A larger study would be necessary to confirm the beneficial effect of high-dose statins in this setting OBJECTIVE Recent studies have suggested that statins reduce atrial fibrillation  after cardiothoracic surgery , but the use of proven prophylactic strategies such as beta-blockers and amiodarone in these studies was not provided . Therefore , we sought to determine whether preoperative statin use could reduce the incidence of  post-cardiothoracic surgery atrial fibrillation in a population who already had a high background use of beta-blockers and appreciable use of prophylactic amiodarone . METHODS Patients undergoing cardiothoracic surgery from the r and omized , controlled Atrial Fibrillation Suppression Trials I , II , and III were evaluated in this nested cohort evaluation . The patients ' demographics , surgical characteristics , medication use , and incidence of post-cardiothoracic surgery atrial fibrillation  ( atrial fibrillation > 5 minutes duration ) were uniformly and prospect ively collected as part of Atrial Fibrillation Suppression Trials I , II , and III . Multivariate logistic regression was used to calculate adjusted odds ratios with 95 % confidence intervals . RESULTS Overall , 331 patients ( 59.6 % ) received a statin preoperatively and 224 patients ( 40.4 % ) did not . The study population had an average age of 67.8 + /- 8.6 years , 77.1 % were male , 14.6 % had valve surgery , 6.1 % had a history of atrial fibrillation , 12.6 % had a history of heart failure , 84.0 % received postoperative beta-blockade , and 44.1 % received postoperative prophylactic amiodarone .  In total , 174 patients ( 31.4 % ) developed post-cardiothoracic surgery atrial fibrillation . Upon multivariate logistic regression , statin use was associated with a reduction in post-cardiothoracic surgery atrial fibrillation ( adjusted odds ratio : 0.60 ; 95 % confidence interval 0.37 - 0.99 ) . Higher intensity statin dosing ( equivalent of > or = 40 mg of atorvastatin ) seemed to be associated with the greatest reductions in post-cardiothoracic surgery atrial fibrillation ( adjusted odds ratio : 0.45 ; 95 % confidence interval 0.21 - 0.99 ) . CONCLUSIONS In a population with appreciable beta-blocker and amiodarone use , adjunctive preoperative statin use was still associated with a 40 % reduction in patients ' odds of developing post-cardiothoracic surgery atrial fibrillation 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 To test the hypothesis that a statin could reduce the recurrence rate of atrial fibrillation after electrical cardioversion ( EC ) , we performed an open , controlled multicenter study . Patients ( n = 114 ) who had atrial fibrillation > 48 hours and who were scheduled for EC were r and omized to receive 40 mg of pravastatin once daily for 3 weeks before and 6 weeks after EC or no drug in addition to st and ard therapy . Pravastatin did not reduce the recurrence rate of atrial fibrillation after EC 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 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 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 Anticoagulants are effective in preventing stroke in those with atrial fibrillation , but most patients remain untreated . AIM To investigate the prevalence of disability , cognitive impairment , and problems with compliance in a representative sample of the elderly with atrial fibrillation , and to determine whether they would want treatment and how they would like services to be arranged . METHOD In a survey of a r and om sample of 4843 elderly subjects , those with atrial fibrillation were identified using electrocardiograms .  Views on treatment were obtained using a structured interview . Disability was assessed using the Office of Population Censuses and Surveys Disability Scale and cognitive status using the Mini Mental State Examination . General practitioners were asked , via question naire , for their views on each subject 's compliance . RESULTS Two hundred and seven elderly people with atrial fibrillation were identified . Almost all subjects expressed a willingness to undertake treatment to prevent stroke and preferred blood testing performed outside of hospital . Disability ( 82.7 % ) , cognitive impairment ( 25.7 % ) , and problems with compliance ( 25.0 % ) were common , but the prevalence of these difficulties was not substantially different from the general elderly population , and in many cases they could be overcome ( e.g. only 10 % of subjects had problems with compliance and no-one who could help them to comply ) . CONCLUSIONS Most elderly people with atrial fibrillation would accept treatment to prevent stroke . Disability , cognitive impairment , and problems with compliance may make it difficult to treat this patient group . An increase in the use of anticoagulants should be accompanied by the development of services appropriate to this frail population PURPOSE R and omized controlled trials have demonstrated that anticoagulant therapy is very effective at preventing stroke among patients with nonrheumatic atrial fibrillation . However , these trials have reported too few strokes for powerful risk factor analysis . Observational studies may provide additional information . The purpose of this study was to identify risk factors in a larger number of patients with stroke and nonrheumatic atrial fibrillation , using case-control methodology . PATIENTS AND METHODS We identified all patients discharged from one hospital over an 8-year period who met our case definition of nonrheumatic atrial fibrillation and ischemic stroke ( n = 134 ) , and compared them with contemporaneous control subjects who were discharged with nonrheumatic atrial fibrillation without stroke ( n = 131 ) . RESULTS Cases and controls were similar in terms of duration of atrial fibrillation ; proportion with paroxysmal atrial fibrillation ; percentage with a past medical history of angina , myocardial infa rct ion , congestive heart failure , diabetes , or smoking ; and mean left atrial size . In contrast , cases were significantly older than controls ( 78.5 versus 74.8 years , p = 0.002 ) and more likely to have a history of hypertension ( 55 % versus 38 % , p = 0.0093 ) . The relative odds for stroke was 1.91 for patients with hypertension , 1.73 for patients older than 75 years , and 3.26 for patients with both factors . CONCLUSIONS Our analysis suggests that age and hypertension should be considered when deciding upon long-term anticoagulant therapy to prevent stroke in patients with nonrheumatic atrial fibrillation PURPOSE Atrial fibrillation ( AF ) is the most frequent arrhythmia that follows coronary artery bypass graft ( CABG ) . Patients developing postoperative AF ( POAF ) have significantly higher mortality rates . The consistent prophylactic effectiveness of statins and vitamin C are well-accepted ; however , no evaluation on combined therapy has been performed . We aim ed at assessing the efficacy of combination therapy with statin and vitamin C in comparison with statin alone in the prevention of post CABG-AF . METHODS In a r and omized double blind clinical trial , 120 c and i date s of CABG were recruited in Tabriz Madani Educational Center in a 15-month period of time . Patients were r and omized into two groups of 60 receiving oral atorvastatin ( 40 mg ) plus oral vitamin C ( 2g/d operation day and 1g/d for five consequent days ) for intervention group and oral atorvastatin ( 40 mg ) for control group . Occurrence of post CABG AF was compared between the two groups . RESULTS There were 60 patients , 43 males and 17 females with a mean age of 61.0±11.5 ( 29 - 78 ) years , in the intervention group and sixty patients , 39 males and 21 females with a mean age of 60.5±11.3 ( 39 - 81 ) years , in the control group .  The post CABG AF occurred in 6 cases ( 10 % ) in the interventional group and 15 patients ( 25 % ) in the controls ( P=0.03 , odds ratio=0.33 , 95 % confidence interval 0.12 - 0.93 ) . CONCLUSION Based on our findings , combination prophylaxis against post CABG AF with oral atorvastatin plus vitamin C is significantly more effective than single oral atorvastatin The fundamental management strategy for atrial fibrillation ( AF ) is still debated . There is no doubt that those patients at risk of thromboembolic events should be offered anticoagulant therapy . However , it is uncertain whether rhythm control ( restoration and maintenance of sinus rhythm ) or rate control ( adjustment to a physiological ventricular rate while allowing AF to continue ) is the preferred primary treatment option for the reduction of symptoms and major cardiovascular ( CV ) outcomes associated with AF . Several well conducted trials comparing the two strategies led to the conclusion that there was little to choose between them . However , guidelines leaned towards recommending rate control as the initial strategy , and reserved rhythm control for those who remained symptomatic . Recently this status quo is being increasingly challenged by the clear demonstration that left atrial catheter ablation is effective at suppressing AF resistant to traditional antiarrhythmic drugs , such as those that failed to demonstrate any superiority when compared with rate control . Also , recently introduced antiarrhythmic therapy may have superior efficacy with regard to reducing unexpected CV hospitalization , CV mortality and stroke . In addition , there is a growing perception that atrial remodelling should be best prevented by early rhythm control rather than delaying until rate control has proven unsatisfactory . For these reasons the results of large r and omised clinical trials , which recruit patients soon after the presentation of AF and compare ' aggressive ' modern rhythm control against the guideline approach of primary rate control , are eagerly awaited . In the meantime the pendulum of clinical opinion has begun to swing towards a rhythm control strategy Background and Purpose — Long-term anticoagulation is routinely used for secondary stroke prevention in atrial fibrillation , often regardless of stroke subtype . Although the role of warfarin in cardioembolic stroke is established , it may not prevent recurrence in other stroke subtypes , even in the presence of atrial fibrillation . Methods — This was a 2-year , prospect i ve , intervention study conducted in a district general hospital . Participants included 386 acute stroke patients with atrial fibrillation . Subjects were characterized for stroke subtype on clinical , neuroimaging , carotid ultrasonographic , and echocardiographic criteria . Eligible patients were treated with adjusted-dose warfarin ( international normalized ratio , 2.0 to 3.0 ) . Aspirin ( 75 to 300 mg/d ) was used in patients with contraindications or those who refused anticoagulation . The main outcome measures were rate of recurrent stroke by subtype and major and minor bleeding complications . Results — The  aspirin group ( n=172 ) was comparable to the  warfarin group ( n=214 ) in terms of age , sex , risk factors , and initial stroke subtype . The rate of recurrent stroke was higher ( 9.5 % versus 4.9 % , P < 0.02 ) but that of major bleeding was lower ( 0.6 % versus 2.5 % , P < 0.05 ) with aspirin . The increased stroke rate with aspirin was due predominantly to cardioembolic recurrence in patients presenting initially with cardioembolic stroke ( 8.4 % versus 1.9 % , P < 0.01 ) . The recurrence rate in aspirin-treated patients who presented with lacunar stroke and atrial fibrillation was similar to that seen in patients receiving warfarin ( 8.8 % versus 8.9 % ) . Conclusions — In this cohort of stroke patients with atrial fibrillation , anticoagulation was superior to aspirin in preventing cardioembolic but not lacunar recurrence . Determination of stroke subtype may be important in anticoagulation decisions for secondary prevention , and further studies are required 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 UNLABELLED We research ed the necessity of quinidine fumarate or acebutolol prophylaxis in patients in whom atrial fibrillation occurred in the postdischarge period and returned to sinus rhythm after coronary artery surgery . DESIGN Prospect i ve review . PATIENTS Since 1992 , 60 patients were chosen in whom atrial fibrillation occurred in early postoperative period . There were no significant differences between them and they were separated into 3 groups . In group I ( 20 patients ) we did not give any drug , in group II ( 20 patients ) quinidine fumarate was given and in group III ( 20 patients ) acebutolol was given and patients were controlled for 90 days . RESULT Atrial fibrillation occurred in one patient in group I , ( 5 % ) , two in group II ( 10 % ) and two in group III ( 10 % ) , ( p < 0.05 ) . Different from the other groups , atrial fibrillation was asymptomatic with low ventricular response in group III . CONCLUSIONS There were no significant differences among three groups statistically , so we suggested that long-term prevention of atrial fibrillation with quinidine fumarate or acebutolol was not necessary after coronary artery surgery A retrospective review of 115 patients who underwent cardiac surgery demonstrated a marked reduction in postoperative atrial fibrillation ( 8 % vs 32 % , p < 0.05 ) in patients who received carvedilol versus metoprolol or atenolol immediately after surgery . A prospect i ve study examining the possibility of carvedilol 's greater efficacy in preventing postoperative atrial fibrillation appears warranted BACKGROUND Inflammation and oxidative stress are associated with atrial fibrillation ( AF ) .  Statins have antioxidant and anti-inflammatory properties . We tested if atorvastatin reduced AF recurrence after DC cardioversion ( CV ) by modifying systemic oxidative stress and inflammation ( NCT00252967 ) . METHODS AND RESULTS In a r and omized , double-blinded , placebo-controlled trial , patients with atrial fibrillation/flutter ( AF ) were r and omized to receive either  atorvastatin 80 mg ( n = 33 )  or placebo ( n = 31 ) before CV . Treatment was continued for 12 months or until AF recurred . Serum oxidative stress markers ( ratios of oxidized to reduced glutathione and cysteine , derivatives of reactive oxygen species , isoprostanes ) and inflammatory markers ( high-sensitivity C- reactive protein [ hs-CRP ] , interleukin-6 [ IL-6 ] , interleukin-1β[IL-1β ] , tumor necrosis factor alpha [ TNFα ] ) were measured at baseline and on follow-up . AF recurred in 22 ( 66.7 % ) of atorvastatin and 26 ( 83.9 % ) of placebo group ( P = 0.2 ) . The adjusted hazard ratio of having recurrence on atorvastatin versus on placebo was 0.99 ( 95 % CI : 0.98 - 1.01 , P = 0.3 ) . There was no significant difference in the time to recurrence using Kaplan-Meier survival estimates ( median [ IR ] : 29 [ 2 - 145 ] days versus 22 [ 7 - 70 ] days , P = 0.9 ) . Although no significant effect was seen on oxidative stress , 2 of 4 inflammatory markers , IL-6 ( adjusted OR : 0.59 , 95 % CI : 0.35 - 0.97 , P = 0.04 ) and hs-CRP ( adjusted OR : 0.59 , 95 % CI : 0.37 - 0.95 , P = 0.03 ) were significantly lowered with atorvastatin  . Cholesterol levels significantly decreased with atorvastatin ( P = 0.03 ) . CONCLUSIONS High-dose atorvastatin did not reduce the recurrence of AF after CV . It reduced selective markers of inflammation without affecting systemic oxidative stress . Failure of atorvastatin to prevent AF recurrence may be due to its failure to affect oxidative stress Background : Snus is a smokeless tobacco product , widely used among Swedish men and increasingly so elsewhere . There is debate as to whether snus is an acceptable “ harm-reduction ” tobacco product . Since snus use delivers a dose of nicotine equivalent to cigarettes , and has been implicated in cardiac arrhythmia because of associations with sudden cardiovascular death , a relation with atrial fibrillation is plausible and important to investigate . Methods : To assess the relation between use of snus and risk of atrial fibrillation , we carried out a pooled analysis of 7 prospect i ve Swedish cohort studies . In total , 274,882 men , recruited between 1978 and 2004 , were followed via the National Patient Register for atrial fibrillation . Primary analyses were restricted to 127,907 never-smokers . Relative risks were estimated using Cox proportional hazard regression . Results : The prevalence of  snus  use was 25 % among never-smokers . During follow-up , 3,069 cases of atrial fibrillation were identified . The pooled relative risk of atrial fibrillation was 1.07 ( 95 % confidence interval = 0.97–1.19 ) in current snus users , compared with nonusers . Conclusion : Findings from this large national pooling project indicate that snus use is unlikely to confer any important increase in risk of atrial fibrillation Objectives : Atrial fibrillation has been associated with increased mortality in the general population and mixed population s of critical ill . Atrial fibrillation can also affect patients during post – cardiac arrest care . We sought to assess the prognostic implication s of atrial fibrillation following out-of-hospital cardiac arrest , including relation to the level of targeted temperature management . Design : A post hoc analysis of a prospect i ve r and omized trial . Setting : Thirty-six ICUs . Patients : We included 897 ( 96 % ) of the 939 comatose out-of-hospital cardiac arrest survivors from the targeted temperature management trial ( year , 2010–2013 ) with data on heart rhythm on day 2 . Interventions : Targeted temperature management at 33 ° C or 36 ° C . Measurements and Main Results : Endpoints included cumulative proportion of atrial fibrillation following out-of-hospital cardiac arrest and 180-day all-cause mortality and specific death causes stratified by atrial fibrillation . Atrial fibrillation on day 2 was used as primary endpoint analyses to exclude effects of short-term atrial fibrillation related to resuscitation and initial management . The cumulative proportions of atrial fibrillation were 15 % and 11 % on days 1 and 2 , respectively . Forty-three percent of patients with initial atrial fibrillation the first day were reported with sinus rhythm on day 2 . No difference was found between the groups treated with targeted temperature management at 33 ° C and 36 ° C . Patients affected by atrial fibrillation had significantly higher 180-day mortality ( atrial fibrillation : 66 % vs no-atrial fibrillation : 43 % ; plogrank < 0.0001 and unadjusted hazard ratio , 1.75 [ 1.35–2.30 ] ; p < 0.0001 ) . The association between atrial fibrillation and higher mortality remained significant ( adjusted hazard ratio , 1.34 [ 1.01–1.79 ] ; p < 0.05 ) adjusted for potential confounders . Atrial fibrillation was independently associated with increased risk of cardiovascular death and multiple-organ failure ( adjusted hazard ratio , 2.07 [ 1.39–3.09 ] ; p < 0.001 ) , whereas no association with higher risk of death from cerebral causes was found . Conclusions : Atrial fibrillation was independently associated with higher mortality , primarily driven by cardiovascular causes and multiple-organ failure , and may thus identify a vulnerable sub population . Whether treatment to prevent atrial fibrillation is associated with an improved prognosis remains to be established BACKGROUND Postoperative atrial fibrillation occurs in 20 % to 40 % of patients undergoing coronary artery bypass grafting ( CABG ) and contributes to delayed recovery , increased length of stay , and increased hospital cost . Measures at preventing postoperative atrial fibrillation have had mixed results . We report a double-blind trial comparing oral amiodarone with placebo for the prevention of atrial fibrillation after CABG . METHODS AND RESULTS All patients undergoing CABG were considered eligible . Exclusion criteria included bradycardia ( < 50 beats/min ) , prior Atrial fibrillation , concurrent therapy with antiarrhythmic drugs , or concomitant valve surgery . Patients were given 2 g of amiodarone ( 73 patients ) or placebo ( 70 patients ) in divided doses 1 to 4 days before surgery and 400 mg daily for 7 days postoperatively . Atrial fibrillation occurred in 24.7 % ( 18 of 43 ) of patients receiving amiodarone and 32 . 8 % ( 23 of 70 ) of patients receiving placebo ( P = .30 ) . Heart rate at onset of atrial fibrillation was 133.4 + /- 26.6 beats/min for amiodarone compared with 152.9 + /- 31.6 beats/min for placebo ( P = . 04 ) . Duration of atrial fibrillation was 10.2 + /- 8.1 hours for amiodarone compared with 16.2 + /- 27.5 hours for placebo ( P = .67 ) . Patients receiving both beta-blockade and amiodarone  had a 16.7 % incidence of atrial fibrillation compared with 31.9 % in the remaining patients ( P = .10 ) . Atrial fibrillation was associated with an increased cost of $ 7011 compared with those who remained in sinus rhythm ( $ 23,869 + /- $ 20,894 vs $ 16,857 + /- $ 5401 in sinus rhythm ) . Hospital cost of those taking amiodarone was $ 18,895 + /- $ 13,267 compared with $ 18,839 + /- $ 11,537.18 for placebo ( P = .42 ) . CONCLUSION Postoperative CABG atrial fibrillation is associated with prolonged hospital stay and increased cost . Prophylactic oral amiodarone did not statistically alter the incidence or duration of atrial fibrillation after CABG , although favorable trends were noted . Hospital cost was not affected by therapy with amiodarone OBJECTIVES The purpose of this study was to evaluate the role of the myocardial redox state in the development of in-hospital complications after cardiac surgery and the effect of statins on the myocardial redox state . BACKGROUND Statins improve clinical outcome after cardiac surgery , but it is unclear whether they exert their effects by modifying the myocardial redox state . METHODS We quantified myocardial superoxide anion ( O(2)(- ) ) and peroxynitrite ( ONOO(- ) ) and their enzymatic sources in sample s of the right atrial appendage ( RAA ) from 303 patients undergoing cardiac surgery who were followed up until discharge , and in 42 patients who were r and omized to receive 3-day treatment with atorvastatin 40 mg/d or placebo before surgery . The mechanisms by which atorvastatin modifies myocardial redox state were investigated in 26 RAA sample s that were exposed to atorvastatin ex vivo . RESULTS Atrial O(2)(- ) ( derived mainly from nicotinamide adenine dinucleotide phosphate [ NADPH ] oxidases ) and ONOO(- ) were independently associated with increased risk of atrial fibrillation , the need for post-operative inotropic support , and the length of hospital stay . Pre-operative atorvastatin treatment suppressed atrial NADPH oxidase activity and myocardial O(2)(- ) and ONOO(- ) production . Ex vivo incubation of RAA sample s with atorvastatin induced a mevalonate-reversible and Rac1-mediated inhibition of NADPH oxidase . CONCLUSIONS There is a strong independent association between myocardial O(2)(-)/ONOO(- ) and in-hospital complications after cardiac surgery . Both myocardial O(2)(- ) and ONOO(- ) are reduced by pre-operative statin treatment , through a Rac1-mediated suppression of NADPH oxidase activity . These findings suggest that inhibition of myocardial NADPH oxidases may contribute to the beneficial effect of statins in patients undergoing cardiac surgery . ( Effects of Atorvastatin on Endothelial Function , Vascular and Myocardial Redox State in High Cardiovascular Risk Patients ; NCT01013103 ) OBJECTIVES The purpose of this study was to investigate the efficacy and safety of amiodarone and propafenone in the conversion of  chronic atrial fibrillation  in a prospect i ve , r and omized , placebo-controlled study . BACKGROUND The effectiveness of amiodarone and propafenone in the treatment of patients with chronic atrial fibrillation has not been adequately studied . METHODS One hundred one patients ( 48 men , mean age 64 + /- 9 years ) with atrial fibrillation lasting > 3 weeks participated in the study . Thirty-four patients received amiodarone ( 300 mg intravenously over 1 h , followed by 20 mg/kg over the next 24 h plus 600 mg orally , in three doses , for 1 week , then 400 mg/day orally , for three weeks ) , 32 received propafenone ( 2 mg/kg intravenously over 15 min , followed by 10 mg/kg over 24 h and then 450 mg/day orally , for one month ) and the remaining 35 served as control subjects . All patients received digoxin and anticoagulant treatment as indicated ( International Normalized Ratio 2 to 3 ) . RESULTS Conversion to sinus rhythm was achieved in 16 ( 47.05 % ) patients who received amiodarone , in 13 ( 40.62 % ) who received propafenone and in none of the control subjects ( p < 0.001 for both groups vs. control subjects ) . Those who converted had smaller atria than those who did not and atrial fibrillation of shorter duration in both the amiodarone and propafenone groups . Treatment was discontinued in one patient of the propafenone group because of significant QRS widening . CONCLUSIONS Amiodarone and propafenone appear to be safe and equally effective in the termination of chronic atrial fibrillation . Left atrial diameter and arrhythmia duration are independent predictors of conversion Context The appropriate level of warfarin anticoagulation in elderly patients with atrial fibrillation has been debated because of an age-associated increase in intracerebral hemorrhage . Contribution Patients with atrial fibrillation and intracerebral hemorrhage who were receiving anticoagulation were matched with similar patients who did not develop intracerebral hemorrhage . Although intracerebral hemorrhage was associated with increasing age ( especially > 85 years ) and increasing international normalized ratios ( INRs ) ( especially > 3.5 ) , the incidence of intracerebral hemorrhage was not statistically different in patients with INRs less than 2.0 and those with INRs between 2.0 and 3.0 . This was true even among those older than 75 years of age . Implication s Risk for intracerebral hemorrhage is not diminished in elderly patients with atrial fibrillation when anticoagulation is maintained below an INR of 2.0 . The Editors Intracranial hemorrhage is the most dangerous complication of warfarin anticoagulant therapy because of its high short-term risk for death and severe neurologic deficit ( 1 - 5 ) . Warfarin is extremely effective in reducing the risk for ischemic stroke associated with atrial fibrillation ( 6 , 7 ) . However , fear of hemorrhage may prompt some physicians to avoid prescribing anticoagulation ( 8) , especially in elderly patients , who appear to have a higher risk for hemorrhage ( 8 - 13 ) . Prominent recent guidelines recommend using lower-intensity anticoagulation for the primary prevention of stroke in patients older than 75 years of age who have atrial fibrillation ( 14 ) and suggest a target international normalized ratio ( INR ) range of 1.6 to 2.5 , despite evidence that the risk for ischemic stroke increases sharply at INRs less than 2.0 ( 15 , 16 ) . Previous studies have not thoroughly addressed the relationship of age and anticoagulation intensity to the risk for intracranial hemorrhage among patients with atrial fibrillation ( 1 , 2 ) . A study of 121 patients with warfarin-associated intracranial hemorrhage used the now-out date d prothrombin time ratio as a measure of anticoagulation intensity and did not specifically address risk in patients with atrial fibrillation ( 1 ) . Earlier studies also included patients receiving anticoagulation for mechanical valves , whose risk-to-benefit ratio is different from that of patients with atrial fibrillation ( 1 , 2 , 17 ) . As the number of individuals with atrial fibrillation increases ( 18 - 21 ) and as a greater proportion of older adults receive anticoagulant therapy ( 22 ) , more precise data are needed about the association of age , INR , and risk for intracranial hemorrhage . Intracranial hemorrhage , although critically important , is an uncommon complication among patients with atrial fibrillation who are receiving anticoagulation . As a result , r and omized trials and cohort studies have difficulty accumulating enough hemorrhage events to powerfully assess risk factors . To address these limitations , we performed a large casecontrol study to evaluate the relationship of increasing age and INR to the risk for intracranial hemorrhage among patients with nonvalvular atrial fibrillation . Methods Case- Patients We performed a casecontrol study comparing 2 groups : 1 ) case- patients with nonvalvular atrial fibrillation who developed intracranial hemorrhage while taking warfarin and 2 ) controls who were receiving anticoagulation for nonvalvular atrial fibrillation but did not develop intracranial hemorrhage . We found potential case- patients using the Partners HealthCare System Research Patient Data Registry , which can identify patients with specific International Classification of Diseases , Ninth Revision , Clinical Modification ( ICD-9-CM ) diagnoses by search ing the Massachusetts General Hospital billing system . We search ed for patients 18 years of age or older who had diagnoses of atrial fibrillation ( ICD-9-CM code 427.31 ) and intracranial hemorrhage ( ICD-9-CM codes 430 , 431 , 432.0 , 432.1 , 432.9 ) at any time from October 1993 to June 2002 . By 1993 , nearly all prothrombin time ratios at the hospital were reported as INRs . We review ed medical records to confirm whether patients were eligible , that is , whether they had intracranial hemorrhage documented by computed tomography or magnetic resonance imaging and documentation of warfarin therapy for atrial fibrillation at the time of the event . We excluded patients who were not taking warfarin at the time of hemorrhage ; those who were receiving anticoagulation for rheumatic heart disease , mitral stenosis , or mechanical valve placement ; those whose event was an ischemic stroke with hemorrhagic conversion ; or those in whom clinical factors may have led to hemorrhage independent of warfarin therapy . These factors included underlying anatomic brain abnormalities ( such as tumors or aneurysms ) , antecedent major head trauma ( skull fracture , trauma with loss of consciousness , motor vehicle injury , or neurosurgical procedures ) , or platelet count less than 50 109 cells/L. Starting in July 1994 , consecutive patients with intracerebral hemorrhage have been enrolled through the Massachusetts General Hospital emergency department as part of a longitudinal cohort study ( 23 ) . To vali date our automated search strategy , we compared our case-patient list with the list of patients identified through the cohort study and found that our search strategy missed only 4 patients with intracerebral hemorrhage . We obtained data on patient date of birth , sex , and ethnicity from computerized records . The type of hemorrhage ( intracerebral , subdural , subarachnoid , intraventricular , or epidural ) was determined through review of radiology reports . Data on presenting symptoms , history of minor head trauma , concomitant aspirin use , and disposition status were obtained from review of the admission medical record and were recorded on a st and ardized data collection form . We recorded the INR measurement obtained closest to the onset of symptoms . If an INR was not available or fresh frozen plasma or vitamin K was administered before the measurement , we considered INR data missing . We review ed medical charts for documentation of the following comorbid conditions : history of cerebrovascular disease ( defined as previous ischemic stroke or carotid artery disease ) , hypertension , congestive heart failure , coronary artery disease , diabetes mellitus , and cancer ( excluding nonmelanoma skin cancer ) . Controls Controls were sample d from patients managed by the Massachusetts General Hospital Anticoagulation Management Services clinic , which followed approximately 1000 patients receiving anticoagulation for atrial fibrillation at any given time during the study period . All patients who were followed in the anticoagulation clinic , received anticoagulation for atrial fibrillation , and had an INR measurement obtained in the same month and year as the given case date were assigned a r and om number . Six controls per case-patient were then r and omly selected . We matched case- patients to controls by INR date to account for any technical changes in INR testing that may have occurred over time . Because of this sampling method , an individual patient could potentially serve as a control for more than 1 case-patient ( 24 ) . Like case- patients , controls were 18 years of age or older ; were receiving anticoagulation for atrial fibrillation ; and had no documented rheumatic heart disease , mitral stenosis , or valve replacement . We sought data on potential confounders of the association of age , INR , and risk for intracranial hemorrhage , focusing on relevant comorbid conditions and combined use of aspirin with warfarin . We review ed available computerized discharge summaries , outpatient clinic notes , and medication lists from up to 2 years before the admission date . If combination warfarin and aspirin use was not documented , patients were considered to not be taking aspirin . Statistical Analysis Case- patients were categorized by type of hemorrhage : intracerebral , subdural , and other ( subarachnoid , intraventricular , or epidural ) . Clinical differences between types of hemorrhage were compared by using the KruskalWallis test for continuous variables ( age and INR ) and chi-square tests for categorical variables . We compared case- patients with controls by using multivariable conditional logistic regression , matching on INR date . Patient age was divided into 5-year intervals that were coded as indicator variables , and the odds of intracranial hemorrhage for each interval were compared with the odds of hemorrhage at a referent age of 70 to 74 years . The INR was divided into a set of ordered intervals that were coded as indicator variables . The relative odds for intracranial hemorrhage at each interval were calculated by using an INR of 2.0 to 3.0 as the referent category . In addition to age , INR , sex , and ethnicity , the following variables were included in the multivariable models to control for potential confounding effects of clinical factors and aspirin use : cerebrovascular disease , hypertension , congestive heart failure , coronary artery disease , diabetes mellitus , cancer , and concomitant aspirin use . If no records were available for review , comorbid conditions and aspirin use were coded as missing . We used multiple imputations for missing data on ethnicity , comorbid conditions , and aspirin use ( 25 ) . We tested for interactions between age and INR and comorbid conditions using 2-way interactions . None of the interaction terms were included in the model if they were not statistically significant when tested collectively . We tested the model 's goodness of fit using the HosmerLemeshow method ( 26 ) . Because the hospital 's anticoagulation clinic did not follow some case- patients before the event , and since factors relating to differences in outpatient care and monitoring could have confounded our analyses , we repeated these analyses in the subgroup of case- patients managed by the anticoagulation clinic . These restricted analyses OBJECTIVES This study compared the efficacy and safety of sotalol and quinidine for conversion and prevention of recurrent  atrial fibrillation .  BACKGROUND Atrial fibrillation is the most common arrhythmia . Pharmacologic therapy has been advocated for both immediate restoration of sinus rhythm and prevention of recurrent atrial fibrillation .  Quinidine is the therapeutic mainstay for both purpose s , but its safety has recently been question ed . Although sotalol has been used successfully to maintain sinus rhythm after direct current cardioversion , its efficacy in pharmacologically reverting atrial fibrillation has not been examined . METHODS Fifty consecutive patients with persistent atrial fibrillation were r and omized to receive quinidine or sotalol for up to 7 days to restore sinus rhythm . Patients were followed up for 6 months . RESULTS Quinidine was more effective than sotalol in terminating atrial fibrillation ( 60 % vs. 20 % , p = 0.009 ) . When nonresponders to drug therapy underwent subsequent direct current cardioversion , total conversion rates in the quinidine and sotalol groups were comparable ( 88 % vs. 68 % , p = 0.17 ) , as was the efficacy of the two drugs in preventing recurrent atrial fibrillation . Side effects necessitating drug discontinuation were more often observed with quinidine . No patient receiving sotalol but four patients receiving quinidine had drug-associated arrhythmia ( torsade de pointes in three patients , sustained ventricular tachycardia in one patient ) . Precordial QT dispersion determined on the surface electrocardiogram ( ECG ) increased with quinidine ( mean + /- SD 34 + /- 9 vs. 44 + /- 16 ms , p = 0.02 ) , indicating enhanced inhomogeneity in ventricular repolarization . There was no change in QT dispersion in patients receiving sotalol ( 36 + /- 18 vs. 40 + /- 17 ms , p = 0.44 ) . CONCLUSIONS Quinidine is more effective than sotalol in terminating atrial fibrillation but is associated with more side effects . The proarrhythmic risk may be related to quinidine 's propensity to increase disparity in ventricular repolarization . This risk warrants careful ECG monitoring during the 1st 4 to 7 days of therapy . Because most proarrhythmic effects occurred shortly after restoration of sinus rhythm , observation should continue > or = 2 to 3 days after sinus rhythm is reestablished AIMS The purpose of the study was to compare the efficacy and safety of sotalol and bisoprolol in the maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation . METHODS Patients ( n=128 ) were r and omized to sotalol ( 80 mg b.i.d . ) or bisoprolol ( 5 mg x day(-1 ) ) . Patients with contraindications to beta-blockers , class III antiarrhythmic drugs or prior treatment with use of study medication for prevention of atrial fibrillation were excluded . Follow-up clinical evaluation was performed 1 day and 1 month after cardioversion and thereafter at 3-month intervals . RESULTS There were no group differences in baseline clinical characteristics . After a follow-up of 12 months , 59 % of all patients were still in sinus rhythm . The fraction remaining in sinus rhythm was calculated for the two groups by Kaplan -- Meier analysis . During follow-up , 41 % of patients on sotalol and 42 % on bisoprolol developed atrial fibrillation ( ns ) . In two patients ( 3.1 % ) on sotalol , life-threatening proarrhythmias ( torsade de pointes tachycardias ) occurred , whereas none were found in the bisoprolol group . Symptomatic bradycardias occurred in two patients on sotalol and three on bisoprolol . CONCLUSION This study demonstrates that sotalol ( 160 mg x day(-1 ) ) and bisoprolol ( 5 mg x day(-1 ) ) are equally effective in maintaining sinus rhythm . Because of the side effects of sotalol , bisoprolol seems to be advantageous for maintenance of sinus rhythm after cardioversion of atrial fibrillation 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 Whether or not to treat patients with non-rheumatic atrial fibrillation with anticoagulants to prevent embolic stroke is a dilemma for physicians . If r and omized trials , currently underway , demonstrate a beneficial effect , the dilemma will not be solved because not all of the relevant factors can be addressed by trials . We used current knowledge about non-rheumatic atrial fibrillation and a method of obtaining patient-derived weights for avoiding stroke from eight medically trained subjects , to determine the overall benefit of anticoagulants and to see what factors were relevant and what effect each might have in deciding whether to use anticoagulant therapy . Using st and ard assumptions , anticoagulants gave an expected benefit for all subjects . The expected benefit ( expressed in terms of lives per 1000 saved due to anticoagulants ) varied between 5.4 and 46.7 . This benefit remained for all subjects when we did a sensitivity analysis for different rates of stroke prevented by anticoagulants and different rates of intracranial hemorrhage caused by anticoagulants . When we used different baseline rates of stroke and different impacts of major hemorrhagic complications the benefit disappeared for 3 and 4 subjects respectively . We found the factors that were most crucial to the decision will not be included in r and omized trials ; the weight that an individual would place on avoiding embolic stroke vs the risk of intracranial bleeding from anticoagulant therapy ; and the rate of embolic stroke that could be expected for the subject at risk . Factors which will be measured in r and omized trials , will change results less substantially : the increased risk of major hemorrhages ; the proportion of strokes that could be prevented by treatment ; the increase in risk of intracranial hemorrhage . This method of analysis suggests that for most patients anticoagulants are beneficial and that the most important factor in determining this result is the value that subjects put on different outcomes Multiple trials have suggested the use of digoxin , digoxin and propranolol , or timolol to prevent atrial fibrillation after coronary artery bypass grafting . No trial has evaluated the efficacy of digoxin verus propranolol . Furthermore , the predictors of postoperative atrial fibrillation and the long-term consequence of atrial fibrillation that reverts to sinus rhythm have not been established . One hundred fifty patients were r and omized to receive no drug , propranolol ( 20 mg every 6 hours ) , or digoxin ( 0.5 mg followed by 0.25 mg daily ) . Twenty-seven patients were excluded from data analysis . In the remaining 123 patients , no preoperative parameter ( age , sex , diabetes , hypertension , smoking , electrocardiographic p wave morphology , or preoperative digoxin or propranolol therapy ) , intraoperative parameter ( bypass time , aortic cross-clamp time , or number of vessels bypassed ) , or postoperative parameter ( peak creatinine kinase , congestive heart failure , or pericarditis ) by univariate or multivariate analysis predicted patients at risk for atrial fibrillation . Sustained atrial fibrillation developed in 37.5 % of control and 32.6 % of digoxin-treated patients . Only 16.2 % of propranolol-treated patients had sustained atrial fibrillation ( p less than 0.03 ) . There were no in-hospital complications in those patients with atrial fibrillation . After 26 + /- 7 months follow-up , those patients with postoperative atrial fibrillation had no increased incidence of angina , cerebral vascular accident , myocardial infa rct ion , or sudden death . Therefore , in this select population , propranolol prophylaxis is effective but discretionary BACKGROUND Atrial fibrillation ( AF ) is common after coronary artery bypass surgery ( CABG ) and results in prolonged hospitalization . The purpose of this study was to evaluate the efficacy of biatrial pacing in preventing post-CABG AF compared with single-site atrial pacing . METHODS AND RESULTS A total of 132 patients who had no history of AF and who underwent CABG were r and omized to 1 of the following 4 groups : biatrial pacing ( BiA ) , left atrial pacing ( LA ) , right atrial pacing ( RA ) , or no pacing ( control ) in postoperative period . Overdrive atrial pacing was performed for 5 days . The incidence of AF was significantly reduced in the BiA group ( 12.5 % ) compared with the other 3 groups ( LA , 36.4 % ; RA , 33.3 % ; control , 41 . 9 % ; P<0.05 ) . The mean length of hospital stay was significantly reduced in the BiA group . At baseline , the mean P-wave duration ( P(dur ) ) and dispersion ( P(dis ) ) were not prolonged . BiA pacing result ed in the most significant percentage of reduction in P(dis ) when compared with the LA or RA groups ( BiA , 42+/-8 % ; LA , 13+/-6 % ; RA , 10+/-9 % ; P<0.05 for BiA versus LA or RA ) . No significant differences existed in mean P(dur ) and P(dis ) between patients who developed AF and those who remained in sinus rhythm at baseline . However , only those patients who remained in sinus rhythm had a significant reduction in mean P(dur ) and P(dis ) after pacing therapy . CONCLUSIONS Biatrial overdrive pacing is more effective in preventing post-CABG AF than single-site atrial pacing ; this therapy also results in a shortened hospital stay . The overall reduction in atrial activation time with BiA pacing was reflected in the reduction in P(dis )
SUMMARY The use of statins was significantly associated with a decreased risk of atrial fibrillation in patients with sinus rhythm .
PURPOSE OF REVIEW Whether statins may prevent  atrial fibrillation  remains a subject of debate .