Regression of electrocardiographic left ventricular hypertrophy and decreased incidence of new-onset atrial...

Area of Science:

• Cardiology
• Hypertension Research
• Electrophysiology

Background:

• Atrial fibrillation (AF) significantly increases mortality and stroke risk, making AF prevention a key clinical goal.
• Electrocardiographic left ventricular hypertrophy (LVH) is a known predictor of AF development.
• The impact of LVH regression on AF incidence remains unclear.

Purpose of the Study:

• To investigate if regression or sustained absence of electrocardiographic LVH during antihypertensive therapy reduces AF incidence.
• To determine if this association is independent of blood pressure levels and specific treatment types.

Main Methods:

• A double-blind, randomized trial involving 8831 hypertensive patients (aged 55-80) with electrocardiographic LVH and no prior AF.
• Patients received either losartan- or atenolol-based regimens, with follow-up for new-onset AF.
• Electrocardiographic LVH was assessed using sex-adjusted Cornell product criteria.

Main Results:

• A lower rate of new-onset AF (14.9 per 1000 patient-years) was observed in patients with LVH regression or absence compared to those with persistent LVH (19.0 per 1000 patient-years).
• Each 1-SD decrease in the Cornell product (LVH measure) was associated with a 12.4% lower rate of new-onset AF.
• Losartan therapy showed a persistent benefit over atenolol in reducing AF development.

Conclusions:

• Reduced electrocardiographic LVH during antihypertensive treatment is linked to a lower incidence of new-onset AF.
• This effect is independent of blood pressure reduction and treatment modality.
• Targeting LVH regression or prevention with antihypertensive therapy may be a strategy to decrease AF incidence.