EFFECTS OF CHRONIC STATIN THERAPY ON LEFT ATRIAL STRUCTURE AND FUNCTION AND RECURRENCE OF ATRIAL FIBRILLATION AFTER CATHETER ABLATION

Abstract

TOPIC: Cardiovascular Disease TYPE: Original Investigations PURPOSE: Acute post atrial fibrillation (AF) ablation treatment with HMG-COA reductase inhibitors (statins) has been shown to improve left atrial (LA) function and decrease recurrence of AF. Effects of chronic, pre-ablation statin therapy on LA function and AF recurrence post- ablation have not been well investigated METHODS: The study cohort included 111 consecutive pts who underwent initial radiofrequency PVI with successful restoration of normal sinus rhythm. End-systole, P-wave onset, and end-diastole 3D LA volumes were assessed with transthoracic echocardiogram <48 hours after the procedure; reservoir, conduit, and booster function were calculated. AF recurrence was documented by 12-lead ECG or an event recorder RESULTS: The study included 33% females, 63+/-10 years old, with HTN in 69%, CHF in 14%, treated diabetes in 15%, CAD in 13%, and chronic lung disease in 6%. Most of statin treated patients had CAD (93 vs. 7% in non-statin group, p<0.001) and a significant proportion had CHF (22 vs. 7%, p=0.028). There were no significant differences in LA reservoir (maximal volume) and LA conduit (passive emptying) function according to the statin therapy status. However, post-ablation LA booster function was significantly lower in statin patients (16+/-12.5 vs. 23.5+/-0.2%, p=0.009).AF recurred in 37% during 26+/-13 months post ablation. Despite increased co-morbidities and decreased post-ablation LA booster function in statin treated patients, rates of AF recurrence were similar in statin and non-statin groups (38 vs. 36%, respectively, p=ns). In logistic regression analysis, CAD, CHF, statin therapy, and indexed by BSA LA volumes were not predictive of AF recurrence. However, increased LA booster function (>30%) was associated with significant reduction in AF recurrence (HR 0.094. 95%CI 0.021-0.411, p<0.002) CONCLUSIONS: Patients of chronic statin therapy referred for AF ablation have significantly increased rates of CAD and CHF, and significantly lower LA booster function immediately post ablation. Despite of that, patients on chronic statin therapy derive similar benefit from AF ablation and experience long-term AF recurrence rates similar to non-statin treated patients CLINICAL IMPLICATIONS: Statin therapy is still vital regardless of its effects on AF and LA booster, and definitely should be continued for all the benefits supported by the fact that it does not affect the AF recurrence rates. DISCLOSURES: No relevant relationships by Majd Al-Ahmad, source=Web Response No relevant relationships by Mikhail Torosoff, source=Web Response