Institute of Cardiology, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome, Italy.
Europace. 2010 May;12(5):649-54. doi: 10.1093/europace/euq044. Epub 2010 Feb 26.
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 (chi(2) = 1.68, P = 0.43, I(2) = 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.
患有永久性起搏器 (PM) 的患者发生心房颤动 (AF) 的风险很高。已经证明，最小化心室起搏模式可以降低此类患者的 AF 发生率，尽管它们不适合患有晚期房室传导疾病的患者。最近的证据表明，3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂（即他汀类药物）可能代表预防高危患者发生 AF 的一种新策略。在本文中，我们试图回顾关于他汀类药物治疗预防 PM 患者 AF 有效性的数据。我们回顾了所有评估他汀类药物治疗对因窦房结功能障碍或房室传导疾病而植入 PM 的患者发生 AF 影响的可用研究。此外，通过直接输入来自每项研究的多 Cox 回归分析中提供的 AF 危险比 (HR) 的对数，进行了随机效应逆方差加权荟萃分析。确定了三项研究，共纳入 552 名患者，其中 159 名患者接受了他汀类药物治疗。随访时间从 1 年到 2.77 年不等。两项研究（一项观察性研究和一项前瞻性随机研究）主要纳入了窦房结功能障碍患者（分别为 70%和 91%的患者人群），并且一致显示他汀类药物对 AF 发生有有益作用。另一方面，纳入主要为房室传导阻滞患者的研究未能显示他汀类药物对 AF 发生的有益作用。累积数据的 AF 发生率 HR 为 0.43（95%置信区间：0.28-0.67，P <0.001）。未检测到纳入研究之间的统计学异质性（chi(2) = 1.68，P = 0.43，I(2) = 0%），尽管在研究设计、患者人群、他汀类药物使用和剂量以及 AF 监测能力方面存在显著的临床差异。他汀类药物可能是预防 PM 患者 AF 发生的一种新的治疗策略，特别是对于那些因窦房结功能障碍而植入 PM 的患者。基于我们的发现，需要一项设计合理的随机临床试验来评估他汀类药物在预防这些患者 AF 中的效用。
