Statins in Secondary Prevention of Atrial Fibrillation

Aim. To study the effect of atorvastatin on the progression of the arrhythmia in hypertensive patients with paroxysmal atrial fibrillation (AF) in the longterm follow-up.Material and methods. Patients with paroxysmal AF (n=65) were included into the study. The patients were divided into two groups depending on the level of lipid metabolism: group I (n=33) received atorvastatin (10-40 mg/day), and control group II (n=32) did not take statins. The duration of follow-up was 4 years. The evolution of the AF clinical course was evaluated by the number of arrhythmia episodes for 3 months. Increase in the frequency of paroxysms of AF over the past 3 months, the appearance of the long-standing persistent AF or permanent AF considered as the arrhythmia progression.Results. The increase in rate and duration of AF episodes was found in 14 (42%) patients of group I and in 13 (41%) patients of group II. Progression of AF was observed with equal frequency in groups I and II. The average value of arrhythmia progression was 10.5% per year in patients of group I and 10.3% in group II. Significant differences between groups in the progression of AF were not found (p=0.2).Conclusion. Atorvastatin in hypertensive patients with paroxysmal AF did not lead to a change in rate and duration of arrhythmia paroxysms. The average value of paroxysmal AF progression was comparable regardless of atorvastatin use

CARDIOPROTECTIVE PROPERTIES OF LISINOPRIL: NEW POSSIBILITIES

Aim. To study the changes in the stiffness of the arterial wall, vasomotor function of the endothelium, and appearance of new cases of atrial fibrillation (AF) in patients with arterial hypertension with long-term treatment with lisinopril.Material and method. 66 hypertensive patients with cardiac sinus rhythm at the age of 48-64 years (mean age 58.4±4.2 years) were included into the study. They were randomized into 2 groups: patients of group 1 (n=35) were prescribed lisinopril or a combination of lisinopril with hydrochlorothiazide over the 5-year follow-up; patients of group 2 (control) did not receive angiotensin converting enzyme inhibitors or angiotensin II receptor blockers. The follow-up duration was from September 2010 until June 2016. It included telephone calls once every 3 months and annual clinical, instrumental and laboratory examination. The new-onset AF was identified by the 24-hour Holter ECG monitoring results and by patient symptom diaries.Results. New-onset AF was registered in 2 patients (6%) in the lisinopril group and in 4 patients (13%) from the control group (p=0.001) over the 5-year follow-up. Lisinopril significantly reduced AF incidence in hypertensive patients. The patients on lisinopril were found to have no significant changes in the left ventricular mass index and left atrial size according to echocardiography done after the 5-year follow-up whereas in the patients of control group both parameters increased significantly. Lisinopril contributed to the maintenance of endothelial vasodilator function and prevented increase in arterial wall stiffness.Conclusion. Long term lisinopril treatment was found to significantly reduce the AF incidence in hypertensive patients over the 5-year follow-up. Lisinopril demonstrated organoprotective properties throughout the cardiovascular disease continuum and can be recommended for primary prevention of arrhythmia in hypertensive patients

The role of obesity in the development of atrial fibrillation: current problem status

Atrial fibrillation (AF) is one of the most common heart rhythm disorders. AF worsens the quality of life of patients and increases the risk of fatal cardiovascular complications. Obesity is a worldwide epidemic which prevalence has doubled in the past 30 years. The role of obesity as one of the predisposing factors for AF is currently being discussed. The modern literature describes several mechanisms of the influence of overweight on the development of arrhythmias: activation of the sympatho-adrenal nervous system, increased activity of the reninangiotensin-aldosterone system, development of arterial hypertension, insulin resistance, and lipid metabolism. Despite the large number of studies in this area, the pathogenesis of the development and progression of AF in obesity is not fully understood.The molecular mechanisms of AF development in obese patients include the occurrence of systemic inflammation. The most significant inflammatory activity is observed in the epicardial adipose tissue. It is proven that pro-inflammatory cytokines and adipocyte dysfunction negatively influence over development of AF. Evaluation of the patient’s clinical status and study of subtle mechanisms of arrhythmogenesis in obese patients allows discussing specific approaches to treatment. This approach is consistent with modern ideas about personalized medicine

Role of epicardial adipose tissue in the development of atrial fibrillation in hypertensive patients

Obesity is a progressing epidemic, the prevalence of which has doubled over the past 30 years. The distribution of adipose tissue is an important factor in predicting the risk of cardiovascular events. The most significant inflammatory activity is characteristic of epicardial adipose tissue (EAT), the role of which in the development of atrial fibrillation (AF) remains a subject of discussion.Aim. To study the effect of EAT size on the development of AF in hypertensive (HTN) patients.Material and methods. The study included 95 patients with HTN aged 38-72 years (mean age, 61,5±1,8 years), including 45 patients with paroxysmal AF (group I) and 50 patients in the comparison group (group II). In order to assess the severity of visceral obesity, all patients underwent a general examination and echocardiography. To determine the EAT volume, cardiac multislice computed tomography was performed.Results. Echocardiography revealed that the EAT thickness was significantly greater in hypertensive patients with paroxysmal AF than in the comparison group: 11,6±0,8 and 8,6±0,4 mm, respectively (p<0,001). According to cardiac multislice computed tomography, a significant increase in EAT volume was revealed in patients of group I (4,6±0,4 ml) compared with group II (3,5±0,25 ml) (p=0,019). In hypertensive patients with paroxysmal AF, a positive moderate relationship between the EAT volume and left atrial volume was revealed (r=0,7, p=0,022). Multivariate analysis showed that in hypertensive patients, EAT thickness >10 mm and volume >6 ml can serve as integral markers of the onset of paroxysmal AF.Conclusion. Integral markers of AF in hypertensive patients are an increase in the EAT thickness >10 mm (odds ratio, 4,1; 95% confidence interval, 1,1-5,6) and volume >6 ml (odds ratio 3,7; 95%, confidence interval 1,0-4,2)