Prevention of Atrial Fibrillation With 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors

A trial fibrillation (AF) is the most common arrhythmia.The prevalence of AF is estimated at 0.4 to 1% of the general population, increasing with age to Ͼ8% in those over 80 years of age.[1][2][3][4][5][6] AF is also the most frequent complication after cardiac surgery, with an incidence of Ϸ30% after coronary artery bypass grafting 7 and up to 60% after valve replacement.8 AF is complicated by an increased risk of stroke and increased mortality.9 Postoperative AF is also associated with a longer hospital stay and causes significant additional costs.8,10 -19 Anticoagulation, rate control, and rhythm control strategies are treatment options of AF.Theoretically, establishment and maintenance of sinus rhythm would be hemodynamically beneficial and should reduce symptoms, morbidity, and mortality.However, large studies could not demonstrate that rhythm control is superior to rate control.20,21 Therefore, strategies to prevent AF (eg, in patients undergoing cardiac surgery) are needed.Here, we review recent mechanistic and clinical evidence suggesting an additional preventive strategy for patients at risk for AF and patients after thoracic and cardiac surgery, namely, treatment with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins).We discuss recent data suggesting that in addition to cholesterol lowering, statins exert antiarrhythmic effects by improving endothelial nitric oxide (NO) availability and reducing inflammation, oxidative stress, and neurohormonal activation. MethodsA systematic literature search was conducted to identify studies evaluating pharmacological strategies to prevent AF published between 1966 and November 2007.The search technique included computerized Medline searches that used the combination of the search term "atrial fibrillation" with "prevention," "treatment," "surgery," "mice," "drugs," "statins," "HMG-CoA reductase," "adrenergic beta antagonists," "angiotensin," "calcium-channel blockers," and "antiarrhythmic agents."Additional studies were identified by reviewing the bibliographies of published reports and the authors' knowledge of the current literature.