Soeby-Land C, Dixen U, Therkelsen S K, Kjaer A
Department of Internal Medicine, Copenhagen University Hospital Herlev, Herlev, Denmark.
Cardiology. 2011;118(4):239-44. doi: 10.1159/000328462. Epub 2011 Jul 5.
The renin-angiotensin-aldosterone system (RAAS) may be activated during atrial fibrillation (AF); our aim was to evaluate the level of aldosterone in patients with either permanent AF, persistent AF scheduled for cardioversion or patients in sinus rhythm (SR). We hypothesized that an increased level of aldosterone is found in patients with AF, decreasing in patients with restored SR.
The study included 60 patients with persistent AF scheduled for elective cardioversion, 19 patients with permanent AF, and a control group of 19 healthy individuals. All patients were examined and their aldosterone levels were measured. Measurement of aldosterone was repeated at follow-up 1, 30 and 180 days after successful cardioversion was achieved. Statistical analysis was conducted using the Kruskal-Wallis rank sum test and the paired t test.
At follow-up, 1, 30, and 180 days after successful cardioversion of the patients with persistent AF, data showed that 49, 27, and 21 patients, respectively, were still in SR. At baseline, median values of plasma aldosterone in the healthy controls, the patients with persistent AF and those with permanent AF were 52, 68, and 80 pg/ml, respectively. The log aldosterone in patients with persistent AF was significantly increased when compared to the control group (p = 0.026). No effect of age and gender was observed. The level of aldosterone decreased over time in patients with AF undergoing cardioversion and maintaining SR, both at a follow-up of 30 days (p = 0.0032) and 180 days (p = 0.037).
Patients with AF had a raised aldosterone level compared to the healthy control individuals. Restoration and maintenance of SR in patients with persistent AF significantly lowered the level of aldosterone up to 180 days after cardioversion, indicating activation of RAAS during AF.
心房颤动（AF）期间肾素 - 血管紧张素 - 醛固酮系统（RAAS）可能被激活；我们的目的是评估永久性房颤患者、计划进行心脏复律的持续性房颤患者或窦性心律（SR）患者的醛固酮水平。我们假设房颤患者醛固酮水平升高，恢复窦性心律的患者醛固酮水平降低。
该研究纳入60例计划进行择期心脏复律的持续性房颤患者、19例永久性房颤患者以及19名健康个体组成的对照组。对所有患者进行检查并测量其醛固酮水平。在成功进行心脏复律后的第1天、30天和180天随访时重复测量醛固酮。采用Kruskal - Wallis秩和检验和配对t检验进行统计分析。
在持续性房颤患者成功进行心脏复律后的第1天、30天和180天随访时，数据显示分别有49例、27例和21例患者仍处于窦性心律。基线时，健康对照组、持续性房颤患者和永久性房颤患者的血浆醛固酮中位数分别为52 pg/ml、68 pg/ml和80 pg/ml。与对照组相比，持续性房颤患者的醛固酮对数显著升高（p = 0.026）。未观察到年龄和性别的影响。进行心脏复律并维持窦性心律的房颤患者，其醛固酮水平在随访30天（p = 0.0032）和180天（p = 0.037）时均随时间下降。
与健康对照个体相比，房颤患者的醛固酮水平升高。持续性房颤患者恢复并维持窦性心律可使心脏复律后长达180天的醛固酮水平显著降低，表明房颤期间RAAS被激活。
