Amit Guy, Katz Amos, Bar-On Shikma, Gilutz Harel, Wagshal Avraham, Ilia Reuven, Henkin Yaakov
Cardiology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Clin Cardiol. 2006 Jun;29(6):249-52. doi: 10.1002/clc.4960290605.
Recent studies have shown conflicting results regarding a protective effect of statin therapy on atrial fibrillation (AF).
We sought to determine whether statins are effective in reducing the risk of developing arrhythmia in a cohort of 264 patients (49% women, mean age [+/-standard deviation] 71 [+/-12] years) with permanent pacemakers who are at high risk for AF.
All patients who underwent implantation of a permanent pacemaker over a 3-year period were eligible for inclusion in the study. We excluded patients with AF at implantation, incomplete medication information, or less than a yearly follow-up visit. Atrial fibrillation was diagnosed by ECG documentation, pacemaker interrogation, and Holter monitoring. Statin treatment was verified through a central pharmacy-computerized database (for most patients) or by chart review. Of the 264 patients, 36% had coronary artery disease.
Atrial fibrillation developed in 70 patients (26%) at a median of 359 days post pacemaker implantation. The incidence rate for the first occurrence of AF post pacemaker implantation among patients treated and not treated with statins was 10.5 versus 9.8 events per 100 patient-years, respectively (p = 0.81). Even after controlling for baseline differences, the hazard ratio (HR) for developing AF among statin users did not achieve statistical significance (HR = 0.59 [0.31-1.12]).
We could not demonstrate that statin therapy had a protective effect against the risk of AF in patients implanted with a permanent pacemaker. The low prevalence of coronary artery disease in our patients may partly explain our results.
近期研究显示，他汀类药物治疗对心房颤动（AF）的保护作用存在相互矛盾的结果。
我们试图确定他汀类药物是否能有效降低264例永久性起搏器植入患者（49%为女性，平均年龄[±标准差]71[±12]岁）发生心律失常的风险，这些患者发生AF的风险较高。
所有在3年期间接受永久性起搏器植入的患者均符合纳入本研究的条件。我们排除了植入时患有AF、药物信息不完整或随访少于一年的患者。通过心电图记录、起搏器问询和动态心电图监测诊断心房颤动。他汀类药物治疗通过中央药房计算机化数据库（大多数患者）或病历审查进行核实。264例患者中，36%患有冠状动脉疾病。
70例患者（26%）在起搏器植入后中位359天发生心房颤动。接受和未接受他汀类药物治疗的患者在起搏器植入后首次发生AF的发生率分别为每100患者年10.5次和9.8次（p = 0.81）。即使在控制基线差异后，他汀类药物使用者发生AF的风险比（HR）也未达到统计学意义（HR = 0.59[0.31 - 1.12]）。
我们无法证明他汀类药物治疗对永久性起搏器植入患者发生AF的风险有保护作用。我们患者中冠状动脉疾病的低患病率可能部分解释了我们的结果。
