Usefulness of statins in preventing atrial fibrillation in patients with permanent pacemaker

A systematic review

Pasquale Santangeli, Giuseppe Ferrante, Gemma Pelargonio, Antonio Dello Russo, Michela Casella, Stefano Bartoletti, Luigi Di Biase, Filippo Crea, Andrea Natale

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Patients with permanent pacemakers (PM) are at high risk of developing atrial fibrillation (AF). Minimal ventricular pacing modalities have been demonstrated to reduce AF in such patients, although they are not suitable for patients with advanced atrioventricular conduction disease. Recent evidences suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (i.e. statins) may represent a new strategy to prevent AF in patients at risk. In this article, we sought to review data regarding the effectiveness of statin therapy in preventing AF patients with a PM. We reviewed all available studies that assessed the effect of statin therapy on the occurrence of AF in patients with PM, implanted due to sinus node dysfunction or atrioventricular conduction disease. Moreover, a random effect inverse variance-weighted meta-analysis was performed, by entering directly the logarithm of the hazard ratio (HR) of AF provided in the multiple Cox regression analyses from each study. Three studies were identified, including 552 patients, of whom 159 received statins. Follow-up ranged from 1 to 2.77 years. Two studies (one observational and one prospective randomized) included predominantly patients with sinus node dysfunction (70 and 91 of patient population, respectively) and, consistently, showed a beneficial effect of statins on the occurrence of AF. On the other hand, the study including predominantly patients with atrioventricular block (60 of patient population) failed to show a beneficial effect of statins on AF occurrence. The HR for AF occurrence for the cumulative data was found to be 0.43 (95 confidence interval: 0.28-0.67, P < 0.001). Statistical heterogeneity between included studies was not detected (χ2 = 1.68, P = 0.43, I2 = 0), although significant clinical differences were found in terms of study design, patient populations, statins use and dosage and AF-monitoring capabilities. Statins may represent a novel treatment strategy to prevent the occurrence of AF in patients with PM, especially for those who had a PM implanted due to sinus node dysfunction. Basing on our findings, a randomized clinical trial with a proper design to evaluate the utility of statins in preventing AF in these patients is warranted.

Original languageEnglish (US)
Pages (from-to)649-654
Number of pages6
JournalEuropace
Volume12
Issue number5
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Atrial Fibrillation
Sick Sinus Syndrome
Population
Atrioventricular Block

Keywords

  • Atrial fibrillation
  • Atrioventricular
  • Block
  • Permanent pacemaker
  • Sinus node dysfunction
  • Statins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Santangeli, P., Ferrante, G., Pelargonio, G., Dello Russo, A., Casella, M., Bartoletti, S., ... Natale, A. (2010). Usefulness of statins in preventing atrial fibrillation in patients with permanent pacemaker: A systematic review. Europace, 12(5), 649-654. https://doi.org/10.1093/europace/euq044

Usefulness of statins in preventing atrial fibrillation in patients with permanent pacemaker : A systematic review. / Santangeli, Pasquale; Ferrante, Giuseppe; Pelargonio, Gemma; Dello Russo, Antonio; Casella, Michela; Bartoletti, Stefano; Di Biase, Luigi; Crea, Filippo; Natale, Andrea.

In: Europace, Vol. 12, No. 5, 2010, p. 649-654.

Research output: Contribution to journalArticle

Santangeli, P, Ferrante, G, Pelargonio, G, Dello Russo, A, Casella, M, Bartoletti, S, Di Biase, L, Crea, F & Natale, A 2010, 'Usefulness of statins in preventing atrial fibrillation in patients with permanent pacemaker: A systematic review', Europace, vol. 12, no. 5, pp. 649-654. https://doi.org/10.1093/europace/euq044
Santangeli P, Ferrante G, Pelargonio G, Dello Russo A, Casella M, Bartoletti S et al. Usefulness of statins in preventing atrial fibrillation in patients with permanent pacemaker: A systematic review. Europace. 2010;12(5):649-654. https://doi.org/10.1093/europace/euq044
Santangeli, Pasquale ; Ferrante, Giuseppe ; Pelargonio, Gemma ; Dello Russo, Antonio ; Casella, Michela ; Bartoletti, Stefano ; Di Biase, Luigi ; Crea, Filippo ; Natale, Andrea. / Usefulness of statins in preventing atrial fibrillation in patients with permanent pacemaker : A systematic review. In: Europace. 2010 ; Vol. 12, No. 5. pp. 649-654.
@article{2a9db6609c9d4189a72a6dec8f5f6acd,
title = "Usefulness of statins in preventing atrial fibrillation in patients with permanent pacemaker: A systematic review",
abstract = "Patients with permanent pacemakers (PM) are at high risk of developing atrial fibrillation (AF). Minimal ventricular pacing modalities have been demonstrated to reduce AF in such patients, although they are not suitable for patients with advanced atrioventricular conduction disease. Recent evidences suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (i.e. statins) may represent a new strategy to prevent AF in patients at risk. In this article, we sought to review data regarding the effectiveness of statin therapy in preventing AF patients with a PM. We reviewed all available studies that assessed the effect of statin therapy on the occurrence of AF in patients with PM, implanted due to sinus node dysfunction or atrioventricular conduction disease. Moreover, a random effect inverse variance-weighted meta-analysis was performed, by entering directly the logarithm of the hazard ratio (HR) of AF provided in the multiple Cox regression analyses from each study. Three studies were identified, including 552 patients, of whom 159 received statins. Follow-up ranged from 1 to 2.77 years. Two studies (one observational and one prospective randomized) included predominantly patients with sinus node dysfunction (70 and 91 of patient population, respectively) and, consistently, showed a beneficial effect of statins on the occurrence of AF. On the other hand, the study including predominantly patients with atrioventricular block (60 of patient population) failed to show a beneficial effect of statins on AF occurrence. The HR for AF occurrence for the cumulative data was found to be 0.43 (95 confidence interval: 0.28-0.67, P < 0.001). Statistical heterogeneity between included studies was not detected (χ2 = 1.68, P = 0.43, I2 = 0), although significant clinical differences were found in terms of study design, patient populations, statins use and dosage and AF-monitoring capabilities. Statins may represent a novel treatment strategy to prevent the occurrence of AF in patients with PM, especially for those who had a PM implanted due to sinus node dysfunction. Basing on our findings, a randomized clinical trial with a proper design to evaluate the utility of statins in preventing AF in these patients is warranted.",
keywords = "Atrial fibrillation, Atrioventricular, Block, Permanent pacemaker, Sinus node dysfunction, Statins",
author = "Pasquale Santangeli and Giuseppe Ferrante and Gemma Pelargonio and {Dello Russo}, Antonio and Michela Casella and Stefano Bartoletti and {Di Biase}, Luigi and Filippo Crea and Andrea Natale",
year = "2010",
doi = "10.1093/europace/euq044",
language = "English (US)",
volume = "12",
pages = "649--654",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - Usefulness of statins in preventing atrial fibrillation in patients with permanent pacemaker

T2 - A systematic review

AU - Santangeli, Pasquale

AU - Ferrante, Giuseppe

AU - Pelargonio, Gemma

AU - Dello Russo, Antonio

AU - Casella, Michela

AU - Bartoletti, Stefano

AU - Di Biase, Luigi

AU - Crea, Filippo

AU - Natale, Andrea

PY - 2010

Y1 - 2010

N2 - Patients with permanent pacemakers (PM) are at high risk of developing atrial fibrillation (AF). Minimal ventricular pacing modalities have been demonstrated to reduce AF in such patients, although they are not suitable for patients with advanced atrioventricular conduction disease. Recent evidences suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (i.e. statins) may represent a new strategy to prevent AF in patients at risk. In this article, we sought to review data regarding the effectiveness of statin therapy in preventing AF patients with a PM. We reviewed all available studies that assessed the effect of statin therapy on the occurrence of AF in patients with PM, implanted due to sinus node dysfunction or atrioventricular conduction disease. Moreover, a random effect inverse variance-weighted meta-analysis was performed, by entering directly the logarithm of the hazard ratio (HR) of AF provided in the multiple Cox regression analyses from each study. Three studies were identified, including 552 patients, of whom 159 received statins. Follow-up ranged from 1 to 2.77 years. Two studies (one observational and one prospective randomized) included predominantly patients with sinus node dysfunction (70 and 91 of patient population, respectively) and, consistently, showed a beneficial effect of statins on the occurrence of AF. On the other hand, the study including predominantly patients with atrioventricular block (60 of patient population) failed to show a beneficial effect of statins on AF occurrence. The HR for AF occurrence for the cumulative data was found to be 0.43 (95 confidence interval: 0.28-0.67, P < 0.001). Statistical heterogeneity between included studies was not detected (χ2 = 1.68, P = 0.43, I2 = 0), although significant clinical differences were found in terms of study design, patient populations, statins use and dosage and AF-monitoring capabilities. Statins may represent a novel treatment strategy to prevent the occurrence of AF in patients with PM, especially for those who had a PM implanted due to sinus node dysfunction. Basing on our findings, a randomized clinical trial with a proper design to evaluate the utility of statins in preventing AF in these patients is warranted.

AB - Patients with permanent pacemakers (PM) are at high risk of developing atrial fibrillation (AF). Minimal ventricular pacing modalities have been demonstrated to reduce AF in such patients, although they are not suitable for patients with advanced atrioventricular conduction disease. Recent evidences suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (i.e. statins) may represent a new strategy to prevent AF in patients at risk. In this article, we sought to review data regarding the effectiveness of statin therapy in preventing AF patients with a PM. We reviewed all available studies that assessed the effect of statin therapy on the occurrence of AF in patients with PM, implanted due to sinus node dysfunction or atrioventricular conduction disease. Moreover, a random effect inverse variance-weighted meta-analysis was performed, by entering directly the logarithm of the hazard ratio (HR) of AF provided in the multiple Cox regression analyses from each study. Three studies were identified, including 552 patients, of whom 159 received statins. Follow-up ranged from 1 to 2.77 years. Two studies (one observational and one prospective randomized) included predominantly patients with sinus node dysfunction (70 and 91 of patient population, respectively) and, consistently, showed a beneficial effect of statins on the occurrence of AF. On the other hand, the study including predominantly patients with atrioventricular block (60 of patient population) failed to show a beneficial effect of statins on AF occurrence. The HR for AF occurrence for the cumulative data was found to be 0.43 (95 confidence interval: 0.28-0.67, P < 0.001). Statistical heterogeneity between included studies was not detected (χ2 = 1.68, P = 0.43, I2 = 0), although significant clinical differences were found in terms of study design, patient populations, statins use and dosage and AF-monitoring capabilities. Statins may represent a novel treatment strategy to prevent the occurrence of AF in patients with PM, especially for those who had a PM implanted due to sinus node dysfunction. Basing on our findings, a randomized clinical trial with a proper design to evaluate the utility of statins in preventing AF in these patients is warranted.

KW - Atrial fibrillation

KW - Atrioventricular

KW - Block

KW - Permanent pacemaker

KW - Sinus node dysfunction

KW - Statins

UR - http://www.scopus.com/inward/record.url?scp=77951968778&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77951968778&partnerID=8YFLogxK

U2 - 10.1093/europace/euq044

DO - 10.1093/europace/euq044

M3 - Article

VL - 12

SP - 649

EP - 654

JO - Europace

JF - Europace

SN - 1099-5129

IS - 5

ER -