THE USE OF ATORVASTATIN FOR THE PREVENTION OF RECURRENT ATRIAL FIBRILLATION AFTER ELECTRICAL CARDIOVERSION IN PATIENTS WITH ISCHEMIC HEART DISEASE

Aim. To study the effect of atorvastatin on the rate of atrial fibrillation (AF) recurrence after electrical cardioversion in patients with ischemic heart disease (IHD) and paroxysmal AF.

Material and Methods. Sixty outpatients and inpatients (aged 30-70 y.o.) with IHD and paroxysmal AF were included into the open controlled randomized study immediately after the restoration of sinus rhythm by electrical cardioversion. Patients were randomized into 2 groups. Patients in Group 1 (n=30) received standard therapy recommended for maintenance of sinus rhythm in paroxysmal AF and atorvastatin (average dose 23.5±3.7 mg/day), and patients in Group 2 (n=30) had only the standard therapy. Routine blood analysis, blood chemistry (transaminases, creatine phosphokinase, creatinine, bilirubin, glucose, lipid profile), daily ECG monitoring, treatment safety evaluation were performed. AF relapse was considered as a primary endpoint.

Results. Significant reduction in the rate of AF recurrence in was revealed in patients treated with atorvastatin. According to daily ECG monitoring AF relapse was recorded in 8.3 and 48% of patients in Group 1 and Group 2, respectively (p<0.001). Episodes of sinus tachycardia decreased on 52.3% (p<0.001) and 48,5% (p<0.01) in patients of the 1st and the 2 nd group, respectively.

Conclusion. The addition of atorvastatin to the standard therapy for maintenance of sinus rhythm reduces effectively the rate of AF recurrence in patients with IHD and paroxysmal AF.

1. Arutyunov G.P., RylovaA.K. Newlessons of4S study and perspectives of statins.Klinicheskaya farmakologiya i terapiya 2000; 4:12-15. Russian (Арутюнов Г.П., Рылова А.К. Новые уроки исследования 4S и перспективы применения статинов. Клиническая фармакология и терапия 2000; 4:12-15).

2. Karpov Y.A. Statines in prevention and treatment of atherosclerosis connected diseases: efficiency and safety. Rational Pharmacother Cardiol 2005; 2: 48-53. Russian (Карпов Ю.А. Статиныв профилактике и лечении связанных с атеросклерозом заболеваний: эффективность и безопасность. Рациональная Фармакотерапия в Кардиологии 2005;2:48-53).

3. La Rosa J. C., Grundy S.M., Waters D.D. et al. Treating to New Targets Investigators. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005;352(14):1425- 1435.

4. Siu C.W., Lau C.P., Tse H.F. Prevention of atrial fibrillation recurrence by statin therapy in patients with lone atrial fibrillation after successful cardioversion. Am J Cardiol 2003;92(11):1343-5.

5. Benjamin E.J., Levy D., Vaziri S.M. et al. Independent risk factors for atrial fibrillation in a populationbased cohort: the Framingham Heart Study. JAMA 1994;271 (11):840-844.

6. WyseD.G., Waldo A.L.,Di Marco J.P. et al. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison ofrate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347(23):1825-1833.

7. Acevedo M, Corbalán R, Braun S et al. C-reactive protein and atrial fibrillation: evidence of an inflam￾matory process in the initiation and perpetuation of the arrhythmia. Int J Cardiol 2006 Apr 14;108(3):326-31.

8. Aviles R.J., Martin D.O., Apperson-Hansen C. et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003;108(24):3006-3010.

9. Boos C.J., Anderson R.A., Lip G.Y. Is atrial fibrillation an inflammatory disorder? Eur Heart J 2006;27(2):136-149.

10. Wyse D., Love J., Yao Q. et al. Atrial fibrillation, a risk factor for increased mortality-an AVID redistry analysis. J Interv Card Electrophysiol 2001;5(3):267-73.

11. WellensH.J. Pulmonary vein ablation in atrial fibrillation: hype or hope. Circulation 2000; 102(21): 2562-2564.

12. Glance J., Garrat C., Woods K., de Bono D. QT dispersion and mortality after myocardial infarction. Lancet 1995; 345(8955): 945-948.

13. Frustaci A., Chimenti C., Bellocci F. et al. Histological substrat of atrial biopsies in patients with lone atrial fibrillation. Circulation 1997; 96(4):1180-1184.

14. Diomede L., Albani D., Sottocorno M. et al. In vivo anti-inflammatory effect of statin is mediated by nonsterol mevalonate products. Arterioscler Thromb Vasc Biol 2001;21(8): 1327-1332.