Effectiveness of aldosterone antagonists for preventing atrial fibrillation after cardiac surgery in patients with systolic heart failure: a retrospective study

• Published in: Clinical research in cardiology 2015-01, Vol.104 (1), p.31-37
• Main Authors: Simopoulos, V., Tagarakis, G., Hatziefthimiou, A., Skoularigis, I., Triposkiadis, F., Trantou, V., Tsilimingas, N., Aidonidis, I.
• Format: Article
• Language: English
• Subjects: Aged; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - physiopathology; Atrial Fibrillation - prevention & control; Cardiac Surgical Procedures - adverse effects; Cardiology; Cardiopulmonary Bypass - adverse effects; Chi-Square Distribution; Coronary Artery Bypass - adverse effects; Female; Greece - epidemiology; Heart Failure, Systolic - diagnosis; Heart Failure, Systolic - physiopathology; Heart Failure, Systolic - surgery; Heart Valves - physiopathology; Heart Valves - surgery; Humans; Incidence; Logistic Models; Male; Medicine; Medicine & Public Health; Middle Aged; Mineralocorticoid Receptor Antagonists - adverse effects; Mineralocorticoid Receptor Antagonists - therapeutic use; Multivariate Analysis; Odds Ratio; Original Paper; Retrospective Studies; Risk Factors; Spironolactone - adverse effects; Spironolactone - analogs & derivatives; Spironolactone - therapeutic use; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-014-0754-7

Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery. There exist consistent experimental and clinical data suggesting that aldosterone antagonists (AAs) may exert beneficial effects regarding electrical and structural remodeling in failing myocardium. Recently, eplerenone (EPL) has been found to reduce the incidence of nonsurgical AF when added to guideline-recommended therapy in patients with systolic heart failure. Based on these findings, we primarily aimed to evaluate by retrospective analysis the impact of the two AAs, EPL and spironolactone (SPL), given at standard therapeutic doses in preventing new-onset POAF in patients the majority of which had a preoperative ejection fraction (EF) below 40 %. A total of 332 patients (298 men/34 women, mean age 64.3 ± 9 years) without history of AF were included in this analysis; 132 of these patients received long-term EPL or SPL in addition to beta-blockade/statins therapy and 200 patients received neither EPL nor SPL. All patients underwent on-pump coronary artery bypass graft (80 %) and/or valvular surgery (20 %). In the nonAA group (EF = 35.8 ± 6 %) 90/200 patients (45 %) had POAF, while in the AA group (EF = 36.2 ± 5 %) only 40/132 patients (30.3 %) developed POAF ( P