Atrial fibrillation and inflammation

Table 1 Statins and atrial fibrillation

Ref.	Study design	Subjects	Conclusion
Kumagai et al[21]	Prospective	Interventional canine sterile pericarditis model; atorvastatin	Atorvastatin group had lower CRP, shorter duration of AF, less inflammation in atrial tissues
Siu et al[25]	Retrospective	62 lone persistent AF, statin vs control	Lower recurrence rate in the statin group
Tveit et al[35]	Prospective	114 patients undergoing electrical cardioversion; pravastatin vs none	Pravastatin did not reduce the recurrence rate of AF
Young-Xu et al[26]	Prospective	449 patients with CAD were followed for 5 yr	Development of AF was lower in statin group
Ozaydin et al[24]	Prospective	48 patients undergoing cardioversion; atorvastatin vs none	81% relative risk reduction in AF recurrence
Ozaydin et al[31]	Observational	264 patients undergoing CABG surgery; any statin	Statin group had lower AF rates
Patti et al[30] (ARMYDA-3)	Prospective	200 patients undergoing CABG surgery; atorvastatin vs placebo	61% reduction in the odds of AF
García-Fernández et al[36]	Prospective	52 patients undergoing cardioversion; atorvastatin vs none	No significant difference in recurrence rate of AF
Ramani et al[27]	Retrospective	1526 patients with ACS; various statins	43% reduction in the odds
Humphries et al[37]	Prospective, observational	625 patiens undergoing cardioversion; any statin	74% reduction in the odds of AF with β-blocker; no effect alone
Hanna et al[42]	Data from a multicenter registry	25 268 patients with LVEF ≤ 40%	Lipid-lowering drug use was associated with reduced odds of AF
Fauchier et al[43]	Meta-analysis	Six studies with 3557 patients	Statins were significantly associated with a decreased risk of AF (P = 0.02)
			Benefit of statins was more marked in secondary prevention of AF
Liu et al[44]	Meta-analysis	Six randomized and 10 observational studies with 7041 patients	No significant effect of statins on AF development (P = 0.09). Observational studies showed that statin use decrease the relative risk for AF by 23%. This effect was greatest in the postoperative patients
Patel et al[46]	Meta-analysis	14 trials with 7402 patients	Statin decreased AF rates by 45%. Decrease was most prominent in postoperative AF
Marín et al[32]	Prospective, observational	234 patients undergoing CABG surgery; any statin	48% reduction in the odds of AF
McLean et al[40]	Two large, randomized trials: PROVE IT-TIMI 22 and A to Z trial	8659 patients with ACS; low- vs high-dose statin therapy	Neither study showed decreased AF risk with high-dose statin therapy
Lertsburapa et al[33]	Observational	555 patients undergoing CABG surgery; any statin	40% reduction in the odds of AF
Kourliouros et al[34]	Retrospective	680 patients undergoing CABG surgery; atorvastatin and simvastatin	Improving benefits with higher dose
Virani et al[39]	Retrospective	4044 patients undergoing CABG surgery; any statin	No effect
Adabag et al[41]	Cohort	13 783 CAD patients	No difference in AF incidence with statin treatment (P = 0.09). However, AF was reduced in a subgroup of patients with congestive heart failure (P = 0.04)

AF: Atrial fibrillation; CABG: Coronary artery bypass grafting; CAD: Coronary artery disease; CRP: C-reactive protein; ACS: Acute coronary syndrome; LVEF: Left ventricular ejection fraction.

Table 2 Polyunsaturated fatty acids and atrial fibrillation

Ref.	Study design	Subjects	Conclusion
Physicians’ Health Study[54]	Prospective	17 679 patients (epidemiological study)	Although statistically insignificant, AF risk is higher in PUFAs group
Danish study[53]	Prospective	47 949 patients (epidemiological study)	Although statistically insignificant, AF risk is higher in PUFAs group
Rotterdam study[55]	Prospective	5184 patients (epidemiological study)	Although statistically insignificant, AF risk is higher in PUFAs group
Mozaffarian et al[51]	Prospective	4815 patients (epidemiological study)	Although statistically insignificant, AF risk is higher in fried fish/fish sandwich group
			Significantly, AF risk is lower in broiled/baked fish group
Calò et al[48]	Prospective	160 patients undergoing CABG surgery	AF risk is significantly lower in PUFAs group
Saravanan et al[49]	Prospective	Patients undergoing CABG surgery	AF risk is significantly lower in PUFAs group

PUFAs: Polyunsaturated fatty acids; AF: Atrial fibrillation; CABG: Coronary artery bypass grafting.

Table 3 Corticosteroids and atrial fibrillation

Ref.	Study design	Subjects	Conclusion
Chaney et al[57]	Prospective	60 patients undergoing CABG surgery; methylprednisolone	No effects of steroids on in the incidence of AF
Yared et al[58]	Randomized	235 patients undergoing CABG or valve surgery	Dexamethasone decreased incidence of new-onset AF
Yared et al[59]	Randomized	78 patients undergoing CABG or valve surgery	Dexamethasone did not decrease incidence of new-onset AF and inflammation
Dernellis et al[17]	Randomized	104 patients undergoing electrical cardioversion	Methylprednisolone decreased plasma CRP levels and AF recurrence
Goldstein et al[61]	Animal study	Canine sterile pericarditis model	Prednisone treatment decreased inflammation, and eliminated atrial arrhythmia inducibility
Halonen et al[60]	Randomized	241 patients undergoing CABG or valve surgery	Corticosteroids decreased the incidence of postoperative AF and serum CRP levels
Baker et al[62]	Meta-analysis	Nine studies with 990 patients undergoing CABG or valve surgery	Positive effects of perioperative corticosteroid use on AF occurrence

AF: Atrial fibrillation; CABG: Coronary artery bypass grafting; CRP: C-reactive protein.

Table 4 Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and atrial fibrillation

Ref.	Study design	Subjects	Conclusion
Murray et al[76]	Prospective study, retrospective analysis	732 patients; AF rhythm control	No difference in AF recurrence
Madrid et al[71]	Prospective (electrical cardioversion)	154 patients; amiodarone only vs amiodarone + irbesartan	Recurrence of AF lower in irbesartan group
Zaman et al[73]	Prospective (electrical cardioversion)	47 patients; ACEI vs no ACEI group	Number of defibrillation attempts required for successful cardioversion was less in ACEI group
Ueng et al[72]	Prospective (electrical cardioversion)	125 patients; amiodarone only vs amiodarone + enalapril	Enalapril group had decreased rate of recurrence
Pedersen et al[65]	Prospective (post-MI)	1577 patients with LV dysfunction post-MI; trandolapril vs control	Trandolapril reduces AF
SOLVD[66]	Prospective study, but retrospective analysis (heart failure)	374 patients with depressed LV function; enalapril vs control	AF rate lower in ACEI group
Val-HeFT[78]	Prospective study, retrospective analysis (heart failure)	4409 patients with; valsartan vs control	ARB lower incidence of AF
CHARM[77]	Prospective study, retrospective analysis (heart failure)	5518 patients; candesartan vs control	ARB lowers incidence of AF in both normal and depressed ejection fraction
L'Allier et al[79]	Retrospective (hypertension)	5463 patients receiving ACEI vs 5463 patients receiving CCB	The incidence of AF was lower in ACEI group
Miceli et al[80]	Retrospective (post-CABG)	10 023 patients undergoing isolated CABG; ACEI vs non-ACEI	ACEI treatment is associated with an increased risk of post-operative AF
Madrid et al[81]	Meta-analysis	Seven trials involving a total of 24 849 patients	There was a significant statistical difference in the development AF with ACEI/ARB treatment
Kalus et al[82]	Meta-analysis	Four trials	There was a significant statistical difference in the development AF with ACEI/ARB treatment
Anand et al[83]	Meta-analysis	Nine randomized controlled trials	The use of ACEIs and ARBs had an overall effect of 18% risk reduction in new-onset AF across the trials and 43% risk reduction in patients with heart failure
Jibrini et al[84]	Meta-analysis	11 randomized trials	Overall, inhibition of the RAAS reduced the RR of AF by 19%. Reduction in AF was greatest in patients after electrical cardioversion and in patients with heart failure
Healey et al[85]	Meta-analysis	11 randomized trials	Overall, ACEIs and ARBs reduced the relative risk of AF by 28%. Reduction in AF was similar between ACEI and ARB and was greatest in patients with heart failure. Overall, there was no significant reduction in AF in patients with hypertension

AF: Atrial fibrillation; CABG: Coronary artery bypass grafting; ACEI: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin receptor blocker; MI: Myocardial infarction; CCB: Calcium channel blocker; LV: Left ventricle; RAAS: Renin angiotensin aldosterone system; RR: Relative risk.