What does this research mean for the field?

Treatment with statins or renin-angiotensin system blockers does not significantly decrease the recurrence rate of atrial fibrillation following ablation, although angiotensin receptor blockers may be associated with a trend toward lower recurrence. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research investigates the effectiveness of statins and RAS blockers on atrial fibrillation recurrence after ablation treatment.

June 25, 2007Journal of Cardiovascular Electrophysiology

The Effects of Statins and Renin‐Angiotensin System Blockers on Atrial Fibrillation Recurrence Following Antral Pulmonary Vein Isolation

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Why the study?

Do statins or renin-angiotensin system blockers reduce the recurrence of atrial fibrillation following ablation in patients with paroxysmal or persistent AF?

Key Points

This research investigates the effectiveness of statins and RAS blockers on atrial fibrillation recurrence after ablation treatment.
Retrospective analysis of 177 patients undergoing ablation for paroxysmal or persistent AF.
Patients were treated with ACE-I, ARB, or statins before and after ablation.
Mean follow-up duration was 13.8 months.
72% of all patients were free of AF at follow-up.
60% (33 of 50) of statin users were AF-free; 55% (17 of 31) of ACE-I users; and 94% (17 of 18) of ARB users were AF-free.
Statins showed no significant reduction in AF recurrence (HR = 1.10, 95% CI: 0.55-2.27, p = 0.79); ARB showed a trend toward lower recurrence (HR 0.17, 95% CI: 0.02-1.34, p = 0.09).

Structured PICO

Do statins or renin-angiotensin system blockers reduce the recurrence of atrial fibrillation following ablation in patients with paroxysmal or persistent AF?

Population

177 consecutive patients (mean age 56 +/- 11 years, 69% male) who underwent ablation for paroxysmal (n=132) or persistent (n=45) atrial fibrillation.

Intervention

Statins (n=50), ACE inhibitors (n=31), or ARBs (n=18) administered prior to ablation and continued for the duration of follow-up.

Comparator

Patients not treated with statins or renin-angiotensin system blockers (observational comparison).

Outcome

Recurrence rate of atrial fibrillation following ablation.

Statins and renin-angiotensin system blockers do not significantly reduce atrial fibrillation recurrence after ablation, though ARBs may warrant further investigation.

Limitations

Retrospective study design
Lack of randomization

Implication

Does not support routine use of statins or RAS blockers post-AF ablation; leaves open need for randomized confirmation.

Abstract

INTRODUCTION: Ablation has emerged as a major treatment option for atrial fibrillation (AF). However, this procedure is limited by a significant rate of AF recurrence. We aimed to examine the effects of statins, angiotensin-converting enzyme inhibitors (ACE-I), and angiotensin receptor blockers (ARB) on the recurrence rate of AF following ablation. METHODS: We conducted a retrospective study of 177 consecutive patients (mean age = 56 +/- 11 yrs, 69% males) who underwent ablation for paroxysmal (n = 132) or persistent AF (n = 45). Patients were treated with ACE-I (n = 31) or ARB (n = 18) or statins (n = 50) prior to ablation and for the duration of follow-up. RESULTS: After a mean follow-up of 13.8 +/- 8.6 months, 72% of patients were free of AF. For patients taking statins, 33 of 50 (60%) were free of AF. In patients treated with ACE-I, 17 of 31 (55%) were free from AF, while in the group of patients treated with ARB, 17 of 18 (94%) were free from AF. Using Cox regression analysis to correct for baseline variables, treatment with statins did not decrease the recurrence rate (HR = 1.10 [95% CI: 0.55-2.27] p = 0.79); nor did treatment with renin angiotensin system (RAS) blockers (HR 0.94 [95% CI: 0.46-1.93] p = 0.87). However, subgroup analysis showed that treatment with ARB was associated with a trend towards lower AF recurrence [HR 0.17, (95% CI: 0.02-1.34) p = 0.09]. CONCLUSIONS: Even though statins and RAS blockers possess anti-inflammatory properties, they did not decrease the recurrence of AF following ablation. However, the subset of patients taking ARB exhibited a trend towards lower AF recurrence. Larger, randomized studies are needed to address this observation.