Atrial fibrillation in primary aldosteronism

Area of Science:

• Endocrinology
• Cardiology
• Nephrology

Background:

• Primary aldosteronism (PA) involves autonomous aldosterone hypersecretion, typically from adrenal adenomas.
• This leads to sodium retention, hypertension, and suppressed renin, distinct from secondary hyperaldosteronism in heart failure.
• While cardiac effects of secondary hyperaldosteronism are known, PA's cardiotoxicity with low renin is increasingly recognized.

Observation:

• This report details five patients diagnosed with primary aldosteronism.
• These patients developed atrial fibrillation (AF) despite lacking structural cardiac lesions.
• In one case, AF occurred even with controlled blood pressure and electrolytes.

Findings:

• Primary aldosteronism may be an underdiagnosed cause of atrial fibrillation.
• PA can precipitate AF in the absence of other identifiable cardiac pathology.
• This association exists even when hypertension and electrolytes are managed.

Implications:

• Consider primary aldosteronism in hypertensive patients presenting with atrial fibrillation.
• Screening for PA is crucial in cases of AF with preserved systolic function and no coronary disease.
• Early diagnosis and treatment of PA may prevent cardiac complications like AF.