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Aldosterone Pathway Blockade to Prevent Atrial Fibrillation: A Systematic Review and Meta-Analysis.

J Neefs1, N W E van den Berg1, J Limpens1

  • 1Department of Cardiology, Heart Center, and Medical Library, Academic Medical Center, Amsterdam, The Netherlands.

International Journal of Cardiology
|January 8, 2017
PubMed
Summary
This summary is machine-generated.

Mineralocorticoid receptor antagonists (MRA) significantly reduce the risk of new-onset and recurrent atrial fibrillation (AF). This suggests MRA treatment is a valuable additive strategy for managing AF, though not effective for post-operative AF.

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Area of Science:

  • Cardiology
  • Pharmacology
  • Electrophysiology

Background:

  • Atrial fibrillation (AF) remains a progressive disease despite current treatments.
  • Atrial fibrosis, linked to aldosterone and mineralocorticoid receptors, is a key substrate for AF.
  • Novel therapeutic strategies targeting AF's arrhythmogenic substrate are needed.

Purpose of the Study:

  • To investigate the efficacy of mineralocorticoid receptor antagonists (MRA) in reducing atrial fibrosis and AF.
  • To evaluate the impact of aldosterone pathway blockade on AF occurrence.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
  • Searched databases (OVID MEDLINE, EMBASE, Cochrane) up to June 2016 for studies on MRA and AF.
  • Calculated summary odds ratios (OR) with 95% confidence intervals (CI) using random-effects models.

Main Results:

  • Included 14 studies with 5332 patients; 45% received MRA (spironolactone or eplerenone).
  • MRA treatment significantly reduced overall AF risk (OR: 0.48), including new-onset (OR: 0.52) and recurrent AF (OR: 0.37).
  • MRA did not significantly reduce post-operative AF (POAF) (OR: 0.60).

Conclusions:

  • Mineralocorticoid receptor antagonists are effective in reducing new-onset and recurrent atrial fibrillation.
  • MRA treatment shows promise as an additive therapeutic strategy for managing AF.
  • MRA efficacy was not demonstrated for post-operative AF.