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Statins and Pacing-Induced Atrial Myopathy: Unraveling Their Role in Atrioventricular Block Patients with Permanent

Yu-Sheng Lin1, Wan-Chun Ho1, Meng-Hung Lin2

  • 1Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.

International Journal of Medical Sciences
|August 6, 2025
PubMed

Insights

Statin therapy did not prevent left atrial myopathy or atrial fibrillation in patients with atrioventricular block and permanent pacemakers. However, statins were linked to reduced all-cause mortality in this population.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Pharmacology

Background:

  • Interventricular dyssynchrony from right ventricular pacing can cause left atrial myopathy and atrial fibrillation in atrioventricular block patients.
  • The efficacy of statin therapy in mitigating these cardiac issues is not well-established.

Purpose of the Study:

  • To investigate the mechanisms underlying left atrial myopathy in this context.
  • To evaluate the clinical outcomes of statin therapy in patients with atrioventricular block and permanent pacemakers.

Main Methods:

  • A multi-faceted approach including animal (miniature pigs), cellular (HL-1 myocytes), and clinical cohort studies (2338 patients).
  • Animal models assessed cardiac effects of RV pacing and atorvastatin.
  • Clinical analysis used inverse probability of treatment weighting to compare statin and non-statin groups regarding atrial fibrillation incidence and mortality.

Main Results:

  • Atorvastatin did not alter left atrial size, function, or fibrosis in the animal model.
  • Cellular studies indicated increased fibrosis markers with mechanical stretch, irrespective of atorvastatin.
  • In the clinical cohort, statin use did not significantly affect left atrial size or atrial fibrillation incidence but was associated with lower all-cause mortality.

Conclusions:

  • Statins do not appear to ameliorate left atrial myopathy or reduce atrial arrhythmias in patients with atrioventricular block and permanent pacemakers.
  • Statin therapy may offer a survival benefit unrelated to direct effects on atrial myopathy or arrhythmias.

Keywords:
atrial myopathyatrioventricular blockstatin

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