Atorvastatin prevents atrial fibrillation in patients with bradyarrhythmias and implantation of an atrial-based or dual-chamber pacemaker: a prospective randomized trial.

Author(s): Tsai CT, Lai LP, Hwang JJ, Wang YC, Chiang FT, Lin JL

Affiliation(s): Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Publication date & source: 2008-07, Am Heart J., 156(1):65-70. Epub 2008 May 15.

Publication type: Randomized Controlled Trial

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 prospective randomized design for 1 year of follow-up. RESULTS: Fifty-two patients (23 males, 70 +/- 13 years old) were randomized 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.