Thromb Haemost 2011; 106(02): 363-370
DOI: 10.1160/TH10-10-0660
Cardiovascular Biology and Cell Signalling
Schattauer GmbH

Use of statins and recurrence of atrial fibrillation after catheter ablation or electrical cardioversion

A systematic review and meta-analysis
Francesco Dentali
1   Department of Clinical Medicine, University of Insubria, Varese, Italy
,
Monica Gianni
2   Department of Cardiology, Hospital of Tradate, Varese, Italy
,
Alessandro Squizzato
1   Department of Clinical Medicine, University of Insubria, Varese, Italy
,
Walter Ageno
1   Department of Clinical Medicine, University of Insubria, Varese, Italy
,
Luana Castiglioni
1   Department of Clinical Medicine, University of Insubria, Varese, Italy
,
Lorenzo Maroni
1   Department of Clinical Medicine, University of Insubria, Varese, Italy
,
Elaine M. Hylek
3   Department of Medicine, Research Unit − Section of General Internal Medicine, Boston University Medical Center, Boston, Massachusetts, USA
,
Anna Maria Grandi
1   Department of Clinical Medicine, University of Insubria, Varese, Italy
,
Eugenio Cazzani
2   Department of Cardiology, Hospital of Tradate, Varese, Italy
,
Achille Venco
1   Department of Clinical Medicine, University of Insubria, Varese, Italy
,
Luigina Guasti
1   Department of Clinical Medicine, University of Insubria, Varese, Italy
› Author Affiliations
Further Information

Publication History

Received: 17 October 2011

Accepted after major revision: 29 April 2011

Publication Date:
25 November 2017 (online)

Summary

Statins have important pleiotropic effects and have been shown to reduce vascular inflammation. Some evidence suggests that statins may have a role in the primary prevention of atrial fibrillation (AF), whereas little is know on the role of statins in patients with existing AF. We performed a meta-analysis of the literature to assess the effect of statins on the recurrence of AF after electrical cardioversion or ablation. MEDLINE and EMBASE databases were searched up to January 2010. Relative risks (RR) and 95% confidence intervals (CIs) were then calculated and pooled using a random-effects model. Statistical heterogeneity was evaluated through the use of I2 statistics. Sixteen studies were included in our systematic review. Statins did not reduce the risk of AF recurrence after ablation (four studies including 750 patients; RR, 1.04; 95% CI, 0.85–1.28, p=0.71; I2 = 34%). Conversely, the use of statins was associated with a significantly reduced risk of AF recurrence after electrical cardioversion (12 studies including 1790 patients; RR, 0.78; 95% CI, 0.67–0.90, p=0.0003; I2 = 34%). This reduction was not statistically significant when the analysis was restricted to randomised controlled trials (RCTs) only (five studies, 458 patients, RR, 0.76; 95% CI, 0.48–1.20). In conclusion, statins may lower the risk of AF recurrence after electrical cardioversion, but not ablation. However, this finding should be considered with caution, and larger RCTs are warranted to confirm our preliminary results.

 
  • References

  • 1 Krahn AD, Manfreda J, Tate RB. et al. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-up Study. Am J Med 1995; 98: 476-484.
  • 2 Goto S, Bhatt DL, Röther J. et al REACH Registry Investigators. Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with athero-thrombosis. Am Heart J 2008; 156: 855-863.
  • 3 Marini C, Di Napoli M, Carolei A. Influence of cholesterol on survival after stroke. Effect of cholesterol on prognosis may rely on negative association with atrial fibrillation. Br Med J 1997; 315: 1159.
  • 4 Chung MK. Randomized trials of rate vs rhythm control for atrial fibrillation. J Interv Card Electrophysiol 2004; 10: 43-53.
  • 5 van Gelder IC, Hagens VE, Bosker HA. et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002; 347: 1834-1840.
  • 6 Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 2000; 356: 1789-1794
  • 7 Wyse DG, Waldo AL, DiMarco JP. et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002; 347: 1825-1833.
  • 8 Opolski G, Torbicki A, Kosior DA. et al. Rate control vs. rhythm control in patients with nonvalvular persistent atrial fibrillation: the results of the Polish How to Treat Chronic Atrial Fibrillation (HOT CAFE) Study. Chest 2004; 126: 476-486.
  • 9 Korantzopoulos P, Kolettis TM, Papathanasiou A. et al. Propafenone added to ibutilide increases conversion rates of persistent atrial fibrillation. Heart 2006; 92: 631-634.
  • 10 Oral H, Pappone C, Chugh A. et al. Circumferential pulmonary vein ablation for chronic atrial fibrillation. N Engl J Med 2006; 354: 934-941.
  • 11 Cappato R, Calkins H, Chen SA. et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 2005; 111: 1100-1105.
  • 12 Frustaci A, Chimenti C, Bellocci F. et al. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 1997; 96: 11804.
  • 13 Aviles RJ, Martin DO, Apperson-Hansen C. et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003; 108: 3006-3010.
  • 14 Engelmann MDM, Svendsen JH. Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J 2005; 26: 2083-2092.
  • 15 Liu T, Li G, Li L, Korantzopoulos P. Association between C-reactive protein and recurrence of atrial fibrillation after successful electrical cardioversion: a metaanalysis. J Am Coll Cardiol. 2007; 49: 1642-1648.
  • 16 Jones SP, Teshima Y, Akao M. et al. Simvastatin attenuates oxidant-induced mitochondrial dysfunction in cardiac myocytes. Circ Res 2003; 93: 697-699.
  • 17 Lefer DJ. Statins as potent antiinflammatory drugs. Circulation 2002; 106: 2041-2042.
  • 18 Young-Xu Y, Jabbour S, Goldberg R. et al. Usefulness of statin drugs in protecting against atrial fibrillation in patients with coronary artery disease. Am J Cardiol 2003; 92: 1379-1383.
  • 19 Liakopoulos OJ, Choi YH, Haldenwang PL. et al. Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30,000 patients. Eur Heart J 2008; 29: 1548-1559.
  • 20 Fuster V, Ryden LE, Cannom DS. et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006; 48: 854-906.
  • 21 Moher D, Liberati A, Tetzlaff J. et al. PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med 2009; 151: 264-269.
  • 22 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. J Am Med Assoc 2000; 283: 2008-2012.
  • 23 McGinn T, Wyer PC, Newman TB. et al. Evidence-Based Medicine Teaching Tips Working Group. Tips for learners of evidence-based medicine: 3. Measures of observer variability (kappa statistic). CMAJ 2004; 171: 1369-1373.
  • 24 Jadad AR, Moore AR, Carrol D. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled Clin Trials 1996; 17: 1-12.
  • 25 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188.
  • 26 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. Br Med J 2003; 327: 557-560.
  • 27 Sterne JA, Egger M, Smith GD. Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. Br Med J 2001; 323: 101-105.
  • 28 García-Fernández A, Marín F, Mainar L. et al. Effect of statins on preventing recurrence of atrial fibrillation after electrical cardioversion. Am J Cardiol 2006; 98: 1299-1300.
  • 29 Naji F, Suran D, Kanic V. et al. Statins and amiodarone improve freedom from recurrence of atrial fibrillation after successful cardioversion. Med Sci Monit. 2009; 15: CR494-498.
  • 30 Almroth H, Höglund N, Boman K. et al. Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebo-controlled multicentre study. Eur Heart J 2009; 30: 827-833.
  • 31 Xia W, Yin Z, Li J. et al. Effects of Rosuvastatin on Asymmetric Dimethylarginine Levels and Early Atrial Fibrillation Recurrence after Electrical Cardioversion. Pacing Clin Electrophysiol 2009; 32: 1562-1566.
  • 32 Koyama T, Sekiguchi Y, Tada H. et al. Comparison of characteristics and significance of immediate versus early versus no recurrence of atrial fibrillation after catheter ablation. Am J Cardiol 2009; 103: 1249-1254.
  • 33 Dogan A, Akcay S, Karabacak M. et al. The effect of pretreatment with renin-angiotensin-aldosterone system blockers on cardioversion success and acute recurrence of atrial fibrillation. Int J Clin Pract 2009; 63: 1017-1023.
  • 34 Baman TS, Gupta SK, Billakanty SR. et al. Time to cardioversion of recurrent atrial arrhythmias after catheter ablation of atrial fibrillation and long-term clinical outcome. J Cardiovasc Electrophysiol 2009; 20: 1321-1325.
  • 35 Park JH, Oh YS, Kim JH. et al. Effect of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Patients Following Ablation of Atrial Fibrillation. Korean Circ J 2009; 39: 185-188.
  • 36 Kim SK, Pak HN, Park JH. et al. Clinical and serological predictors for the recurrence of atrial fibrillation after electrical cardioversion. Europace 2009; 11: 1632-1638.
  • 37 Humphries KH, Lee M, Sheldon R. et al CARAF Investigators. Statin use and recurrence of atrial fibrillation after successful cardioversion. Am Heart J 2007; 154: 908-913.
  • 38 Richter B, Derntl M, Marx M. et al. Therapy with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and statins: no effect on ablation outcome after ablation of atrial fibrillation. Am Heart J 2007; 153: 113-119.
  • 39 Al Chekakie MO, Akar JG, Wang F. et al. The effects of statins and renin-angiotensin system blockers on atrial fibrillation recurrence following antral pulmonary vein isolation. J Cardiovasc Electrophysiol. 2007; 18: 942-946.
  • 40 Ozaydin M, Varol E, Aslan SM. et al. Effect of atorvastatin on the recurrence rates of atrial fibrillation after electrical cardioversion. Am J Cardiol 2006; 97: 1490-1493.
  • 41 Watanabe E, Arakawa T, Uchiyama T. et al. High-sensitivity C-reactive protein is predictive of successful cardioversion for atrial fibrillation and maintenance of sinus rhythm after conversion. Int J Cardiol 2006; 108: 346-353.
  • 42 Tveit A, Grundtvig M, Gundersen T. et al. Analysis of pravastatin to prevent recurrence of atrial fibrillation after electrical cardioversion. Am J Cardiol 2004; 93: 780-782.
  • 43 Siu CW, Lau CP, Tse HF. Prevention of atrial fibrillation recurrence by statin therapy in patients with lone atrial fibrillation after successful cardioversion. Am J Cardiol 2003; 92: 1343-1345.
  • 44 Can I, Demir K, Ozdemir K. et al. Atorvastatin did not prevent recurrence of atrial fibrillation in addition to antiarrhythmic therapy after electrical cardioversion. European Heart J 2007; 28 Suppl. Abstract 809.
  • 45 Penning-van Beest F, Termorshuizen F, Goettsch W. et al. Adherence to evidence-based statin guidelines reduces the risk of hospitalizations for acute myocardial infarction by 40%: a cohort study. Eur Heart J 2007; 28: 154-159.
  • 46 Fauchier L, Pierre B, de Labriolle A. et al. Antiarrhythmic effect of statin therapy and atrial fibrillation a meta-analysis of randomized controlled trials. J Am Coll Cardiol 2008; 51: 828-835.
  • 47 Boos CJ, Anderson RA, Lip GY. Is atrial fibrillation an inflammatory disorder?. Eur Heart J 2006; 27: 136-149.
  • 48 Cai H, Li Z, Goette A. et al. Downregulation of endocardial nitric oxide synthase expression and nitric oxide production in atrial fibrillation: potential mechanisms for atrial thrombosis and stroke. Circulation 2002; 106: 2854-2858.
  • 49 Mihm MJ, Yu F, Carnes CA. et al. Impaired myofibrillar energetics and oxidative injury during human atrial fibrillation. Circulation 2001; 104: 174-180.
  • 50 Han W, Fu S, Wei N. et al. Nitric oxide overproduction derived from inducible nitric oxide synthase increases cardiomyocyte apoptosis in human atrial fibrillation. Int J Cardiol 2008; 130: 165-173.
  • 51 Adam O, Neuberger HR, Böhm M. et al. Prevention of atrial fibrillation with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Circulation 2008; 118: 1285-1293.
  • 52 Adam O, Lavall D, Theobald K. et al. Rac1-induced connective tissue growth factor regulates connexin 43 and N-cadherin expression in atrial fibrillation. J Am Coll Cardiol 2010; 55: 469-480.
  • 53 Wright M, Haïssaguerre M, Knecht S. et al. State of the art: catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2008; 19: 583-592.
  • 54 Hylek EM, Evans-Molina C, Shea C. et al. Major Hemorrhage and Tolerability of Warfarin in the First Year of Therapy Among Elderly Patients with Atrial Fibrillation. Circulation 2007; 115: 2689-2696.
  • 55 Hylek EM, Go AS, Chang Y. et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. New Engl J Med 2003; 349: 1019-1026.