Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery. Effect of statin dose on incidence of atrial fibrillation: data from the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) and Aggrastat to Zocor (A to Z) trials. Oral vitamin C administration reduces early recurrence rates after electrical cardioversion of persistent atrial fibrillation and attenuates associated inflammation. Statin therapy for the prevention of atrial fibrillation trial (SToP AF trial). Atorvastatin Given prior to Electrical Cardioversion Does Not Affect the Recurrence of Atrial Fibrillation in Patients with Persistent Atrial Fibrillation Who Are on Antiarrhythmic Therapy Role of anticoagulation therapy after pulmonary vein antrum isolation for atrial fibrillation treatment Effect of atorvastatin on the recurrence rates of atrial fibrillation after electrical cardioversion. Randomized Trial of Atorvastatin for Reduction of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: Results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) Study Effect of Cardiac Resynchronization on the Incidence of Atrial Fibrillation in Patients With Severe Heart Failure Ascorbate Attenuates Atrial Pacing-Induced Peroxynitrite Formation and Electrical Remodeling and Decreases the Incidence of Postoperative Atrial Fibrillation Oral amiodarone reduces incidence of postoperative atrial fibrillation. Statin use is associated with a reduction in atrial fibrillation after noncardiac thoracic surgery independent of C-reactive protein. Typical, atypical, and asymptomatic presentations of new-onset atrial fibrillation in the community: Characteristics and prognostic implications. Prognostic impact of types of atrial fibrillation in acute coronary syndromes. Effect of preoperative atorvastatin therapy on atrial fibrillation following off-pump coronary artery bypass grafting. Ibutilide to expedite ED therapy for recent-onset atrial fibrillation flutter. High-sensitivity C-reactive protein, statin therapy, and risks of atrial fibrillation: an exploratory analysis of the JUPITER trial. Postoperative oral amiodarone as prophylaxis against atrial fibrillation after coronary artery surgery. Comparison of pharmacological and electrical cardioversion in permanent atrial fibrillation after prosthetic cardiac valve replacement: A prospective randomized trial Statin for prevention of atrial fibrillation after off-pump coronary artery bypass grafting in Japanese patients. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery. Performance of an expedited rhythm control method for recent onset atrial fibrillation in a community hospital. Anemia and reduced kidney function as risk factors for new onset of atrial fibrillation (from the Ibaraki prefectural health study).
Ablation outcomes were investigated in patients with and without statin pretreatment before cardiac surgery with concomitant surgical ablation for atrial fibrillation ( AF ) . A prospect i ve cohort study was performed containing 149 patients ( n=73 statin group vs. n=76 control group ) undergoing on-pump cardiac procedures with surgical ablation for paroxysmal or persistent AF . Measured outcomes were freedom from AF in the intensive care unit , discharge and at three and six months follow-up and perioperative markers of inflammation ( white blood cell count , C-reactive protein ) . Independent predictors for freedom from AF were assessed . Groups did not differ with respect to EuroSCORE , New York Heart Association class , left atrial size , anti-arrhythmic drug therapy or aortic cross-clamp time . Statin therapy had no impact on postoperative inflammatory markers . Freedom from AF was more frequent in the statin group at discharge ( P=0.07 ) and after three and six months ( P<0.05 ) . Subgroup analysis showed that statin pretreatment was associated with higher rates of freedom from AF for paroxysmal AF at three and six months and for persistent AF after six months ( P<0.05 ) . Importantly , statin-pretreatment was independently predictive for freedom from AF at discharge [ odds ratio ( OR ) : 3.21 ; 95 % confidence interval ( CI ) : 1.2 - 8.55 ; P=0.02 ] and at three months ( OR : 2.91 ; 95 % CI : 1.14 - 7.45 ; P=0.026 ) . Statin therapy prior to ablation surgery improves postoperative freedom from AF for paroxysmal and persistent AF in cardiac surgery patients BACKGROUND Inflammation has been suggested as a factor in the initiation and maintenance of  atrial fibrillation ( AF ) . Several observational studies have suggested that statins , presumably through their anti-inflammatory properties , decrease the risk of AF . METHODS We analyzed 2 large , r and omized trials , PROVE IT-TIMI 22 and phase Z of the A to Z trial , which compared lower- versus higher-intensity statin therapy to evaluate whether higher-intensity statin therapy lowered the risk of AF onset during the 2 years of follow-up . We hypothesized that higher-intensity statin therapy would decrease the risk of AF when compared to lower-intensity statin therapy . From each trial , patients experiencing the onset of AF during follow-up were identified from the adverse event reports . RESULTS Neither study showed a decreased AF risk with higher-dose statin . In PROVE IT-TIMI 22 , 2.9 % versus 3.3 % in the high- versus st and ard-dose statin therapy , respectively , experienced the onset of AF over 2 years ( OR 0.86 , 95 % CI 0.61 - 1.23 , P = .41 ) . In A to Z , rates were 1.6 % versus 0.99 % , respectively ( OR 1.58 , 95 % CI 0.92 - 2.70 , P = .096 ) . In both trials , C-reactive protein levels ( plasma or serum ) tended to be higher among patients experiencing the onset of AF . CONCLUSION Our r and omized comparison among 8659 patients found that higher-dose statin therapy did not reduce the short term incidence of AF among patients after acute coronary syndromes when compared with st and ard dose statin treatment BACKGROUND Inflammation and oxidative stress have been recently implicated in the pathophysiology of atrial fibrillation ( AF ) . The aim of this study was to examine the potential benefit of vitamin C on the early recurrence rates and on inflammatory indices after successful cardioversion of persistent AF , as well as to investigate the time course of changes in these indices post-cardioversion . METHODS We prospect ively studied 44 consecutive patients after successful electrical cardioversion of persistent AF .  All patients received st and ard treatment and were r and omised in one to one fashion to either oral vitamin C administration or no additional therapy . We followed-up the patients for 7 days performing successive measurements of white blood cell ( WBC ) count , C-reactive protein ( CRP ) , fibrinogen , and ferritin levels . RESULTS One week after successful cardioversion , AF recurred in 4.5 % of patients in the vitamin C group and in 36.3 % of patients in the control group ( p=0.024 ) . Compared to baseline values , inflammatory indices decreased after cardioversion in patients receiving vitamin C but did not change significantly in the control group . A significant variance was found in the serial measurements of WBC counts ( F=5.86 , p=0.001 ) and of fibrinogen levels ( F=4.10 , p=0.0084 ) in the two groups . In the vitamin C group CRP levels were lower on the seventh day ( p<0.05 ) . CRP and fibrinogen levels were higher in patients who relapsed into AF compared to patients who maintained sinus rhythm ( F=2.77 , p=0.044 and F=3.51 , p=0.017 , respectively ) . CONCLUSIONS These findings suggest that vitamin C reduces the early recurrence rates after cardioversion of persistent AF and attenuates the associated low-level inflammation . These effects indicate that therapeutic approaches targeting at inflammation and oxidative stress may exert favourable effects on atrial electrical remodeling BACKGROUND Inflammation and oxidative stress are associated with atrial fibrillation ( AF ) .  Statins have antioxidant and anti-inflammatory properties . We tested if atorvastatin reduced AF recurrence after DC cardioversion ( CV ) by modifying systemic oxidative stress and inflammation ( NCT00252967 ) . METHODS AND RESULTS In a r and omized , double-blinded , placebo-controlled trial , patients with atrial fibrillation/flutter ( AF ) were r and omized to receive either  atorvastatin 80 mg ( n = 33 )  or placebo ( n = 31 ) before CV . Treatment was continued for 12 months or until AF recurred . Serum oxidative stress markers ( ratios of oxidized to reduced glutathione and cysteine , derivatives of reactive oxygen species , isoprostanes ) and inflammatory markers ( high-sensitivity C- reactive protein [ hs-CRP ] , interleukin-6 [ IL-6 ] , interleukin-1β[IL-1β ] , tumor necrosis factor alpha [ TNFα ] ) were measured at baseline and on follow-up . AF recurred in 22 ( 66.7 % ) of atorvastatin and 26 ( 83.9 % ) of placebo group ( P = 0.2 ) . The adjusted hazard ratio of having recurrence on atorvastatin versus on placebo was 0.99 ( 95 % CI : 0.98 - 1.01 , P = 0.3 ) . There was no significant difference in the time to recurrence using Kaplan-Meier survival estimates ( median [ IR ] : 29 [ 2 - 145 ] days versus 22 [ 7 - 70 ] days , P = 0.9 ) . Although no significant effect was seen on oxidative stress , 2 of 4 inflammatory markers , IL-6 ( adjusted OR : 0.59 , 95 % CI : 0.35 - 0.97 , P = 0.04 ) and hs-CRP ( adjusted OR : 0.59 , 95 % CI : 0.37 - 0.95 , P = 0.03 ) were significantly lowered with atorvastatin  . Cholesterol levels significantly decreased with atorvastatin ( P = 0.03 ) . CONCLUSIONS High-dose atorvastatin did not reduce the recurrence of AF after CV . It reduced selective markers of inflammation without affecting systemic oxidative stress . Failure of atorvastatin to prevent AF recurrence may be due to its failure to affect oxidative stress Objective : In this study , our aim was to evaluate the effect of a higher dose of atorvastatin on the recurrence rate of atrial fibrillation ( AF ) after electrical cardioversion ( EC ) in addition to antiarrhythmic therapy . Subjects and Methods : 48 patients with persistent AF were included in this study . The patients were r and omized to an atorvastatin 40-mg treatment group and a control group . Atorvastatin was started 3 weeks before EC and was continued for 2 months after EC . EC was performed using biphasic shocks after 3 weeks of treatment with the orally administered anticoagulant warfarin .  Lipid and inflammatory parameters ( high-sensitivity C-reactive protein , white blood cell count and fibrinogen level ) were evaluated at the baseline and before EC . The endpoint of this study was electrocardiographically confirmed recurrence of AF of > 10 min . Results : There were no significant differences in baseline characteristics and lipid and inflammatory marker levels between the treatment and control groups . Total cholesterol and low-density lipoprotein levels were significantly decreased in patients taking atorvastatin for 2 months compared with baseline values ( 174 ± 31 vs. 129 ± 25 mg/dl , p = 0.001 , and 112 ± 23 vs. 62 ± 20 mg/dl , p = 0.001 , respectively ) , while no significant change occurred in control patients ( 168 ± 26 vs. 182 ± 29 mg/dl , p = 0.07 , and 99 ± 18 vs. 108 ± 26 mg/dl , p = 0.1 , respectively ) . At the end of the 2-month follow-up period , 9 patients ( 20.5 % ) experienced AF recurrence , and there was no significant difference in AF recurrence rate between the treatment and control groups ( 26 vs. 13 % ; p = 0.2 ) . Conclusion : Atorvastatin therapy prior to EC does not prevent the recurrence of arrhythmia in patients with persistent AF who are receiving antiarrhythmic therapy Background Atrial fibrillation ( AF ) increases the risk of atrioembolic stroke . However , the role of anticoagulation therapy ( OAT ) in preventing cerebrovascular accidents ( CVA ) after intracardiac echocardiography-guided pulmonary vein antrum isolation ( ICE-PVAI ) is still unclear . In the present study , we evaluated the incidence of CVA following the interruption of OAT 3 months after ICE-PVAI . Methods Between September 2002 and March 2004 , 85 consecutive patients ( 72 men , mean age 62 ± 7 years ) underwent ICE-PVAI for symptomatic drug-refractory AF . Heart disease was present in 61 patients ( 72 % ) ( left ventricular ejection fraction = 58 ± 6 % , LA diameter 44 ± 6 mm ) . Eighty-five consecutive patients who underwent electrical cardioversion ( EC ) for AF , matched for age , sex and heart disease , served as a control group . After 3 months , OAT was stopped unless one of the following conditions was observed : ( i ) AF-recurrence ; ( ii ) severe pulmonary vein stenosis ; ( iii ) non-good atrial contractility on transesophageal echocardiography ; or ( iv ) other indications for OAT . Results In the study group , OAT was stopped after 3 months in 77 patients ( 90 % ) and no CVA occurred during the remaining follow-up ( 15 ± 7 months ) . In the control group , 1 month after EC , OAT was stopped by the referring physician in 29 patients ( 34 % ) . A stroke occurred in five patients ( 6 % ) ( P = 0.09 ; mean P = 0.059 ) during follow-up . In two of these ( 2 % ) , the stroke was fatal . Conclusions Stopping OAT 3 months after ICE-PVAI seems to be safe in patients without AF recurrences after the first 3 months following ablation . Further r and omized-controlled studies are needed to confirm these preliminary data To study the effect of atorvastatin on recurrence of atrial fibrillation ( AF ) after electrical cardioversion ( EC ) , 48 patients with AF lasting 48 hours who were scheduled for EC were r and omized to the atorvastatin ( group I ) and control ( group II ) groups . Six patients in group I ( 25 % ) and 2 patients in group II ( 8.3 % ) had spontaneous conversion before EC ( p > 0.05 ) . The end point was the recurrence of AF during 3 months of follow-up . Eighteen patients in group I ( 12.5 % ) and 11 patients in group II ( 45.8 % ) had recurrence ( p = 0.01 , log-rank test ) . With the Cox proportional model , the predictors of recurrence included a body mass index of 25 to 30 kg/m2 ( relative risk [ RR ] 0.07 , 95 % confidence interval [ CI ] 0.008 to 0.59 ) , body mass index > or = 30 kg/m2 ( RR 0.24 , 95 % CI 0.08 to 0.72 ) , AF duration of > or = 3 months ( RR 0.28 , 95 % CI 0.09 to 0.83 ) , diabetes mellitus ( RR 0.34 , 95 % CI 0.12 to 0.98 ) , and left atrial diameter of > or = 45 mm ( RR 0.23 , 95 % CI 0.07 to 0.74 ) . Atorvastatin was associated with a significantly reduced risk of developing AF ( unadjusted RR 0.23 , 95 % CI 0.064 to 0.82 , p = 0.024 ) . This association remained significant after adjustment for these predictors ( adjusted RR 0.19 , 95 % CI 0.052 to 0.72 , p = 0.01 ) . High-sensitivity C-reactive protein levels at baseline were not different between the 2 groups ( p = 0.92 ) . Although the high-sensitivity C-reactive protein levels decreased significantly 48 hours after EC compared with the baseline levels in group I ( 2.82 + /- 1.46 vs 2.56 + /- 1.3 mg/dl , p = 0.02 ) , no significant change occurred in group II ( 2.87 + /- 0.8 vs 2.84 + /- 0.8 mg/dl , p = 0.09 ) . In conclusion , atorvastatin decreased the recurrence rate of AF after EC Background — Atrial fibrillation ( AF ) after cardiac surgery is associated with increased risk of complications , length of stay , and cost of care . Observational evidence suggests that patients who have undergone previous statin therapy have a lower incidence of postoperative AF . We tested this observation in a r and omized , controlled trial . Methods and Results — Two hundred patients undergoing elective cardiac surgery with cardiopulmonary bypass , without previous statin treatment or history of AF , were enrolled . Patients were r and omized to atorvastatin ( 40 mg/d , n=101 ) or placebo  ( n=99 ) starting 7 days before operation . The primary end point was incidence of postoperative AF ; secondary end points were length of stay , 30-day major adverse cardiac and cerebrovascular events , and postoperative C-reactive protein ( CRP ) variations . Atorvastatin significantly reduced the incidence of AF versus placebo ( 35 % versus 57 % , P=0.003 ) . Accordingly , length of stay was longer in the placebo versus atorvastatin arm ( 6.9±1.4 versus 6.3±1.2 days , P=0.001 ) . Peak CRP levels were lower in patients without AF ( P=0.01 ) , irrespective of r and omization assignment . Multivariable analysis showed that atorvastatin treatment conferred a 61 % reduction in risk of AF ( odds ratio 0.39 , 95 % confidence interval 0.18 to 0.85 , P=0.017 ) , whereas high postoperative CRP levels were associated with increased risk ( odds ratio 2.0 , 95 % confidence interval 1.2 to 7.0 , P=0.01 ) . The incidence of major adverse cardiac and cerebrovascular events at 30 days was similar in the 2 arms . Conclusions — Treatment with atorvastatin 40 mg/d , initiated 7 days before surgery , significantly reduces the incidence of postoperative AF after elective cardiac surgery with cardiopulmonary bypass and shortens hospital stay . These results may influence practice patterns with regard to adjuvant pharmacological therapy before cardiac surgery Background — Atrial fibrillation/flutter ( AF ) and heart failure often coexist ; however , the effect of cardiac resynchronization therapy ( CRT ) on the incidence of AF and on the outcome of patients with new-onset AF remains undefined . Methods and Results — In the CArdiac REsynchronisation in Heart Failure ( CARE-HF ) trial , 813 patients with moderate or severe heart failure were r and omly assigned to pharmacological therapy alone or with the addition of CRT . The incidence of AF was assessed by adverse event reporting and by ECGs during follow-up , and the impact of new-onset AF on the outcome and efficacy of CRT was evaluated . By the end of the study ( mean duration of follow-up 29.4 months ) , AF had been documented in 66 patients in the CRT group compared with 58 who received medical therapy only ( 16.1 % versus 14.4 % ; hazard ratio 1.05 ; 95 % confidence interval , 0.73 to 1.50 ; P=0.79 ) . There was no difference in the time until first onset of AF between groups . Mortality was higher in patients who developed AF , but AF was not a predictor in the multivariable model ( hazard ratio 1.17 ; 95 % confidence interval , 0.82 to 1.67 ; P=0.37 ) . In patients with new-onset AF , CRT significantly reduced the risk for all-cause mortality and all other predefined end points and improved ejection fraction and symptoms ( no interaction between AF and CRT ; all P>0.2 ) . Conclusions — Although CRT did not reduce the incidence of AF , CRT improved the outcome regardless of whether AF developed Atrial fibrillation ( AF ) , the most common chronic arrhythmia , increases the risk of stroke and is an independent predictor of mortality . Available pharmacological treatments have limited efficacy . Once initiated , AF tends to self-perpetuate , owing in part to electrophysiological remodeling in the atria ; however , the fundamental mechanisms underlying this process are still unclear . We have recently demonstrated that chronic human AF is associated with increased atrial oxidative stress and peroxynitrite formation ; we have now tested the hypothesis that these events participate in both pacing-induced atrial electrophysiological remodeling and in the occurrence of AF following  cardiac surgery . In chronically instrumented dogs , we found that rapid ( 400 min−1 ) atrial pacing was associated with attenuation of the atrial effective refractory period ( ERP ) . Treatment with ascorbate , an antioxidant and peroxynitrite decomposition catalyst , did not directly modify the ERP , but attenuated the pacing-induced atrial ERP shortening following 24 to 48 hours of pacing . Biochemical studies revealed that pacing was associated with decreased tissue ascorbate levels and increased protein nitration ( a biomarker of peroxynitrite formation ) . Oral ascorbate supplementation attenuated both of these changes . To evaluate the clinical significance of these observations , supplemental ascorbate was given to 43 patients before , and for 5 days following , cardiac bypass graft surgery . Patients receiving ascorbate had a 16.3 % incidence of postoperative AF , compared with 34.9 % in control subjects . In combination , these studies suggest that oxidative stress underlies early atrial electrophysiological remodeling and offer novel insight into the etiology and potential treatment of an enigmatic and difficult to control arrhythmia . The full text of this article is available at http://www.circresaha.org BACKGROUND Atrial fibrillation ( AF ) is a common occurrence after heart operations that use cardiopulmonary bypass . It can cause life-threatening complications as well as delay discharge and increase hospitalization costs . The purpose of this study was to evaluate the effect of orally administered low-dose amiodarone on the incidence of new onset postoperative AF . METHODS In this prospect i ve study , 226 consecutive adult patients ( group A ) who had various heart operations utilizing cardiopulmonary bypass between April and November of 1998 at the University of Miami/Jackson Memorial Hospital , were given oral amiodarone ( 200 mg three times a day ) , starting immediately after arrival in the intensive care unit until the day of hospital discharge . The incidence of new AF in this group of patients was assessed and compared with a historical group of 239 patients ( group B ) who had had cardiac operations with cardiopulmonary bypass in the preceding 9 months at the same institution . RESULTS Preoperative patient characteristics and procedure types were similar in the two groups . Among the 226 patients in group A , 13 ( 5.7 % ) had history of AF . Of the remaining 213 patients , new-onset AF occurred postoperatively in 10 ( 4.7 % ) . Among the 239 patients in group B , 16 ( 6.7 % ) had history of AF . Of the remaining 223 patients , 44 ( 19.7 % ) developed new-onset AF ( p < 0.001 ) . Group A patients had a shorter length of hospital stay than those in group B ( 6.5 versus 7.8 days ) but had a similar incidence of complications other than AF ( 23 of 226 patients in group A versus 24 of 239 in group B ) . The drug was well tolerated . CONCLUSIONS Postoperative low-dose amiodarone given orally to patients who had cardiopulmonary bypass was well tolerated and appeared to reduce the incidence of new-onset AF and decrease the length of hospital stay STUDY OBJECTIVES The level of C-reactive protein ( CRP ) has been shown to be elevated in patients with atrial fibrillation/flutter ( AF ) unrelated to surgery , and statins are known to lower the CRP level . To determine whether an elevated CRP level predisposes the patient to postoperative AF and whether statin use is associated with a reduced AF incidence , we studied a consecutive group of patients who were at risk for AF after undergoing thoracic surgery ( age , > or = 60 years ) . DESIGN AND SETTING A prospect i ve study in a tertiary care cancer center of 131 patients ( mean [ + /- SD ] age , 73 + /- 6 years ) who had undergone major lung or esophageal resection .  High-sensitivity CRP and interleukin (IL)-6 levels were measured before surgery , on arrival at the postanesthesia care unit , and on the first morning after surgery . Continuous telemetry was used for 72 to 96 h to detect AF . RESULTS AF occurred in 38 of 131 patients ( 29 % ) at a median time after surgery of 3 days . Although CRP and IL-6 levels increased significantly ( p < 0.001 ) in response to surgery , patients with or without AF did not differ in perioperative values . In a stepwise logistic regression , statin use was associated with a threefold decrease in the odds of developing AF ( odds ratio [ OR ] , 0.26 ; 95 % confidence interval [ CI ] , 0.08 to 0.82 ; p = 0.022 ) and a greater PR interval ( OR , 1.11 per 5-ms increments ; 95 % CI , 1.01 to 1.22 ; p = 0.027 ) predicted an increase in the risk of AF . CONCLUSIONS The preoperative use of statins was associated with a protective effect against postoperative AF independent of CRP levels . In contrast to AF in the general population , early markers of inflammation did not predict the postoperative occurrence of AF BACKGROUND The prognostic significance of the clinical presentation of atrial fibrillation ( AF ) is poorly defined . OBJECTIVE The purpose of this study was to determine the frequency , associations , and prognostic impact of different clinical presentations of new-onset AF . METHODS One thous and patients with incident AF in Olmsted County , Minnesota , were r and omly selected ( 2000 - 2010 ) . Patients with AF that was complicated at presentation ( heart failure [ n = 71 ] , thromboembolism [ n = 24 ] ) , provoked ( n = 346 ) , or unable to determine symptoms ( n = 83 ) were excluded . In the remaining patients , characteristics and prognosis associated with different types of symptoms were examined . RESULTS Among 476 patients , 193 had typical ( palpitations ) , 122 had atypical ( other non-palpitation symptoms ) , and 161 had asymptomatic AF presentation . Patients with typical presentation had lower CHA2DS2-VASc scores ( mean 2.3 ± 2 ) compared to atypical and asymptomatic presentation ( mean 3.2 ± 1.8 and 3.3 ± 1.9 , respectively ; P < .001 ) . Fifty-nine cerebrovascular events and 149 deaths ( n = 49 cardiovascular ) were documented over median 5.6 and 6.0 years , respectively . Atypical and asymptomatic AF conferred higher risks of cerebrovascular events compared to typical AF after adjustment for CHA2DS2-VASc score and age ( hazard ratio [ HR ] 3.51 , 95 % confidence interval [ CI ] 1.65 - 7.48 , and HR 2.70 , 95 % CI 1.29 - 5.66 , respectively ) , and associations remained statistically significant after further adjustments including comorbidities and warfarin use . Asymptomatic AF was associated with an increased risk of cardiovascular ( HR 3.12 , 95 % CI 1.50 - 6.45 ) and all-cause mortality ( HR 2.96 , 95 % CI 1.89 - 4.64 ) compared to typical AF after adjustment for CHA2DS2-VASc score and age . CONCLUSION The type of clinical presentation may have important implication s for the prognosis of new-onset AF in the community Atrial fibrillation ( AF ) has been established as an independent predictor of long-term mortality after acute myocardial infa rct ion . However , this is less well defined across the whole spectrum of acute coronary syndromes ( ACSs ) . The Acute Coronary Syndrome Prospect i ve Audit is a prospect i ve multicenter registry with 12-month outcome data for 3,393 patients ( 755 with ST-segment elevation myocardial infa rct ion , 1942 with high-risk non-ST-segment elevation ACS [ NSTE-ACS ] , and 696 with intermediate-risk NSTE-ACS ) . A total of 149 patients ( 4.4 % ) had new-onset AF and 387 ( 11.4 % ) had previous AF .  New-onset AF was more , and previous AF was less frequent in those with ST-segment elevation myocardial infa rct ion than in those with high-risk NSTE-ACS or intermediate-risk NSTE-ACS ( p < 0.001 ) . Compared to patients without arrhythmia , patients with new-onset AF and previous AF were significantly older and had more high-risk features at presentation ( p < 0.004 ) . Patients with new-onset AF more often had left main coronary artery disease , result ing in a greater rate of surgical revascularization ( p < 0.001 ) . Only new-onset AF result ed in adverse in-hospital outcomes ( p < 0.001 ) . Only patients with previous AF had greater long-term mortality ( hazard ratio 1.42 , p < 0.05 ) . New-onset AF was only associated with a worse long-term composite outcome ( hazard ratio 1.66 , p = 0.004 ) . However , the odds ratio for the composite outcome was greatest for patients with new-onset AF with intermediate-risk NSTE-ACS ( odds ratio 3.9 , p = 0.02 ) than for those with high-risk NSTE-ACS ( odds ratio 2.0 , p = 0.01 ) or ST-segment elevation myocardial infa rct ion ( odds ratio 1.4 , p = 0.4 ) . In conclusion , new-onset AF was associated with worse short-term outcomes and previous AF was associated with greater mortality even at long-term follow-up . The prognostic burden of new-onset AF differed with the type of ACS presentation BACKGROUND Atrial fibrillation ( AF ) after coronary artery bypass grafting ( CABG ) is still the most common postoperative arrhythmic complication . Previous studies report that patients undergoing preoperative statin  therapy had a lower incidence of postoperative AF . This study aim ed to assess the effect of preoperative atorvastatin therapy on preventing AF following off-pump CABG in a r and omized , controlled trial . METHODS AND RESULTS The 140 consecutive patients undergoing elective off-pump CABG , without a history of AF or previous statin treatment , were enrolled and r and omly assigned to a statin ( atorvastatin 20 mg/day , n=71 ) or a control group ( placebo , n=69 ) starting 7 days preoperatively . The primary endpoint was the occurrence of postoperative AF ; secondary endpoints were major adverse in-hospital cardiac and cerebrovascular events and identification of variables predicting postoperative AF .  Atorvastatin significantly reduced the incidence of postoperative AF and the postoperative peak C-reactive protein ( CRP ) level vs placebo ( 14 % vs 34 % , P=0.009 ; 126.5 + /-22.3 vs 145.2 + /-31.6 mg/L , P<0.0001 ) . Logistic regression analysis showed preoperative atorvastatin treatment was an independent factor associated with a significant reduction in postoperative AF ( odds ratio ( OR ) 0.219 , P=0.005 ) , whereas a high postoperative CRP level was associated with increased risk ( OR 2.011 , P=0.013 ) . CONCLUSIONS Administration of atorvastatin 20 mg/day , initiated 1 week before elective off-pump CABG and continued in the postoperative period , significantly decreases postoperative AF OBJECTIVE Ibutilide is a type III antiarrhythmic agent approved for the pharmacologic conversion of atrial fibrillation ( AF ) and atrial flutter ( AFl ) . Previous studies conducted outside the ED setting have demonstrated conversion rates of 60 % to 80 % . This response has been highest in patients with recent-onset AF-AFl . These observations and the 4-hour half-life of ibutilide suggest that it may be an excellent drug with which to treat AF-AFl in the ED . The purpose of the study was to examine the efficacy and safety of ibutilide in terminating AF-AFl in patients who present to the ED with symptoms of less than 3 days ' duration , neither angina nor heart failure , and no comorbid conditions that require admission . METHODS Among 36 enrolled patients , the admission electrocardiogram demonstrated AF in 26 and AFl in 10 .  Ibutilide 1 mg was administered intravenously for 10 minutes . If sinus rhythm was not present 10 minutes after the infusion concluded , a second infusion of 1 mg was given . Successful conversion was defined as restoration of sinus rhythm within 1 hour after the last dose of ibutilide . RESULTS Sixteen ( 61.5 % ) of 26 patients with AF and 9 ( 90 % ) of 10 patients with AFl converted to sinus rhythm ( overall conversion rate=69 % ) . The mean time to arrhythmia termination was 19+/-9 minutes . The mean stay in the ED was 16.2 hours . No significant complications occurred . CONCLUSION We conclude that ibutilide is an excellent therapy option for restoring sinus rhythm in the ED . Its use may obviate the need for admission , avoid the risks and inconveniences of general anesthesia to perform electrical cardioversion , and reduce the ED length of stay in selected patients with recent-onset atrial arrhythmias AIMS Increasing evidence supports a role for inflammation in promoting  atrial fibrillation ( AF ) and statins have anti-inflammatory effects that may be relevant for the prevention of AF . However , studies of statin therapy and incident AF have yielded mixed results and not focused on individuals with an underlying pro-inflammatory response . We studied whether high-sensitivity C-reactive protein is associated with incident AF and whether treatment with rosuvastatin is associated with a lower incidence of AF compared with placebo . METHODS AND RESULTS We r and omized men and women with LDL cholesterol < 130 mg/dL and high-sensitivity C-reactive protein ≥2 mg/L to receive either rosuvastatin 20 mg daily or placebo .  Atrial fibrillation was determined from treatment-blind adverse event reports . Among 17 120 participants without prior history of arrhythmia , each increasing tertile of baseline high-sensitivity C-reactive protein was associated with a 36 % increase in the risk of developing AF ( 95 % CI : 1.16 - 1.60 ; P-trend < 0.01 ) . Allocation to rosuvastatin when compared with placebo was associated with a 27 % reduction in the relative risk of developing AF during the trial period ; specifically , AF was reported among 138 participants in the placebo group and 100 in the rosuvastatin group ( incidence rate 0.78 vs. 0.56/100 person-years , HR : 0.73 , 95 % CI : 0.56 - 0.94 , P = 0.01 ) . The exclusion of participants who developed a major cardiovascular event prior to the report of AF yielded similar results . CONCLUSION Within the JUPITER trial cohort of individuals selected for underlying inflammation , increasing levels of high-sensitivity C-reactive protein were associated with an increased risk of incident AF and r and om allocation to rosuvastatin significantly reduced that risk OBJECTIVE To assess the prophylactic effect of postoperative oral amiodarone on the incidence and severity of atrial fibrillation ( AF ) after coronary artery surgery . DESIGN Prospect i ve , r and omized , blinded , controlled study . SETTING University hospital . PARTICIPANTS Patients who had coronary artery surgery ( n = 200 ) . INTERVENTIONS Patients in group 1 ( n = 100 ) received oral amiodarone , 15 mg/kg , 4 hours after arrival in the intensive care unit , followed by 7 mg/kg/d until hospital discharge . Patients in group 2 ( n = 100 ) received placebo . MEASUREMENTS AND MAIN RESULTS Incidence , duration , and recurrence of new episodes of AF and maximal ventricular rate response were recorded from day 0 until hospital discharge . Side effects related to amiodarone and complications induced by new-onset AF were noted . The incidence of new-onset AF ( 12 % v 25 % ) and maximal ventricular rate response ( 120 + /- 21 beats/min v 135 + /- 24 beats/min ) were significantly lower in the amiodarone group . There were no side effects related to the administration of amiodarone . The incidence of complications induced by AF was comparable between the 2 groups . CONCLUSION Postoperative prophylactic oral amiodarone after coronary artery surgery is safe and effective in reducing the incidence of new-onset AF and maximal ventricular rate response Objective To compare the efficacy of electrical versus pharmacological cardioversion following prosthetic cardiac valve replacement in patients with permanent atrial fibrillation ( AF ) . Methods Patients with permanent AF who had undergone prosthetic cardiac valve replacement , who had a cardiothoracic ratio ≤0.5 and a left atrial diameter ≤50 mm for ≥6 months after surgery were r and omly divided to receive either electrical or pharmacological cardioversion . Patients in the electrical cardioversion group were given direct-current synchronized electrical defibrillation under general anaesthesia . Patients in the pharmacological cardioversion group were given oral combination therapy with amiodarone , captopril and simvastatin for 3 months . Results A total of 115 patients received either electrical cardioversion ( n = 59 ) or pharmacological cardioversion ( n = 56 ) ; reversion to sinus rhythm occurred in 98.3 % and 26.8 % , respectively . Recurrence rates were similar in the two groups ( 3.4 % and 6.7 % for electrical and pharmacological cardioversion , respectively ) . No deaths or severe complications were reported . Conclusion Electrical cardioversion has a favourable safety profile and appears to be a more effective method than pharmacological cardioversion for the treatment of permanent AF after cardiac valve replacement , once the heart has returned close to its normal size BACKGROUND The purpose of the present study was to assess the preventive effect of preoperative statin treatment on  atrial fibrillation ( AF ) after elective isolated off-pump coronary artery bypass grafting ( off-pump CABG ) in propensity score-matched Japanese patients . METHODS AND RESULTS Among 770 consecutive patients undergoing isolated CABG by the same surgeon ( 99.2 % with off-pump technique without conversion to cardiopulmonary bypass ) between 2002 and 2009 , after excluding emergency ( n=150 ) , chronic AF ( n=30 ) , and use of cardiopulmonary bypass ( n=6 ) , 584 patients were retrospectively review ed . Of this cohort , 364 patients received statin  at least 5 days before operation and 220 patients received no statin . We identified 195 propensity score-matched pairs . Propensity scores were created based on 8 preoperative factors ( C statistics , 0.69 ) . There was no significant difference between the 2 groups in baseline characteristics , perioperative medications , or operative procedures . AF occurred in 14.4 % in the statin group and in 24.6 % in the no statin group ( P=0.01 ) . Multivariate logistic regression including potential univariate predictors identified statin ( odds ratio [ OR ] = 0.49 ; 95 % confidence interval [ 95%CI ] = 0.22 - 0.81 ; P=0.01 ) , age ( OR = 1.33 per 10-year increase ; 95%CI = 1.04 - 1.69 ; P=0.02 ) , and transfusion ( OR = 2.21 ; 95%CI = 1.38 - 3.55 ; P=0.01 ) as independent predictors of postoperative AF . CONCLUSIONS Preoperative statin significantly reduces the incidence of AF after elective isolated off-pump CABG in Japanese patients BACKGROUND  Atrial fibrillation ( AF ) after coronary artery bypass graft ( CABG ) surgery is still the most common arrhythmic complication . This study evaluated whether pretreatment with atorvastatin protects against AF after off-pump CABG . METHODS One hundred twenty-four patients without a history of AF or previous statin use , who were scheduled to undergo elective off-pump CABG , were enrolled . Patients were r and omized to control group ( n = 62 ) or to atorvastatin group ( n = 62 ) who were administered  atorvastatin 20 mg/d for 3 days before the surgery . Primary outcome was the incidence of postoperative AF . Secondary outcomes were major adverse cardiac and cerebrovascular events , persistent AF at 1 month , and identification of the markers to predict inhospital postoperative AF . RESULTS The incidence of AF was significantly lower in the atorvastatin group than in the control group ( 13 % vs 27 % , P = .04 ) . The incidence of major adverse cardiac and cerebrovascular events and persistent AF at 1 month was similar in comparisons between the groups . Postoperative peak N-terminal pro-brain natriuretic peptide levels were significantly higher in the patients with AF ( P = .03 ) . Multivariate analysis identified pretreatment with atorvastatin as an independent factor associated with a significant reduction in postoperative AF ( odds ratio 0.34 , P = .04 ) . Higher postoperative peak N-terminus pro-B-type natriuretic peptide levels were associated with the development of postoperative AF ( odds ratio 1.02 per 100 pg/mL , P = .03 ) . CONCLUSIONS Pretreatment with atorvastatin significantly reduced the occurrence of postoperative AF after off-pump CABG BACKGROUND A st and ard approach to recent onset atrial fibrillation ( AF ) in the emergency department ( ED ) in the United States has not been established . PURPOSE The purpose of this prospect i ve clinical trial was to determine how an ED protocol emphasizing rhythm control for recent onset AF compared similar patients receiving  st and ard therapy  in the same facility . METHODS We enrolled consecutive patients presenting to our community hospital with recent onset AF into a protocol , which called for rhythm control with procainamide and if unsuccessful electrical cardioversion and discharge home . We compared this prospect i ve cohort with matched historical controls . Primary outcome was admission rate . We also compared ED conversion rates and lengths of stay ( LOS ) . We reported 30-day data on the study group including ED recidivism , recurrent AF , outpatient follow-up , and any important adverse events . RESULTS Fifty-four patients were enrolled in the study group with 4 being admitted compared with 30 of 50 in the historical control group . Ninety-four percent of the study group converted compared with 28 % in the historical control . Both hospital and ED LOS were significantly shorter for the study group . Six patients had recurrent AF , and 4 of those returned to the ED . CONCLUSION An ED protocol that uses rhythm control decreased hospital admission and LOS , and there were no adverse events at 30 days Chronic kidney disease ( CKD ) is a potential independent risk factor for  atrial fibrillation ( AF ) .  It remains unclear whether anemia is synergistically associated with increased risk of AF onset  in subjects with CKD . We evaluated the association of kidney function , hemoglobin ( Hb ) , and their combination with new-onset AF in a population -based cohort study . We conducted a 15-year prospect i ve cohort study of 132,250 Japanese subjects aged 40 to 79 years who participated in annual health checkups from 1993 .  Kaplan-Meier survival analysis was used to compare freedom from new-onset AF between groups classified by estimated glomerular filtration rate grade , Hb grade , and their combination . Cox proportional hazard model analysis was used to estimate hazard ratios ( HRs ) for new-onset AF . During a 13.8-year mean follow-up period , 1,232 ( 0.93 % ) subjects with  new-onset AF were identified . Lower estimated glomerular filtration rate and lower Hb grade s were significantly associated with a higher incidence of new-onset AF . Multivariate HRs and 95 % confidence intervals ( CIs ) of new-onset AF were 1.38 ( 1.21 to 1.56 ) for mild CKD group , 2.56 ( 2.09 to 3.13 ) for CKD group , and 1.50 ( 1.24 to 1.83 ) for anemia group . Borderline Hb level was not significantly associated with increased risk for new-onset AF ( HR 1.07 , CI 0.91 to 1.25 , p = 0.4284 ) . In the model with interaction term between CKD and anemia , the risk was significantly higher ( p = 0.0343 for the interaction ) than that predicted by each factor independently . In conclusion , decreased kidney function and lower Hb level are associated with increased risk for new-onset AF , especially when both are present
Data from different observational trials have shown that treatment with statins significantly reduces the incidence of new-onset AF in the primary and secondary prevention .
The data are insufficient to recommend the use of statins before EC .
Finally , perioperative statin therapy may represent an important non-antiarrhythmic adjunctive therapeutic strategy for the prevention of postoperative AF
The aim of the present systematic review is to present an overview of the evidence linking atrial fibrillation ( AF ) , inflammation and oxidative stress , with emphasis on the potential of statins to decrease the incidence of different types of AF , including new-onset AF , after electrical cardioversion ( EC ) and after cardiac surgery .
Observational and clinical trials have studied the impact of statin therapy on new-onset , post-EC or postoperative AF .