Incidence and progression of atrial fibrillation in patients with and without heart failure using mineralocorticoid receptor antagonists: a meta-analysis.

2024-01-03

Sampaio Rodrigues, Thalys

Garcia Quarto, Levindo Jose

Nogueira, Savio Carvalho

Koshy, Anoop N

Mahajan, Rajiv

Sanders, Prashanthan

Ekinci, Elif I

Burrell, Louise M

Farouque, Omar

Lim, Han S

Atrial fibrillation

Heart failure

Meta-analysis

Mineralocorticoid receptor antagonist

Upstream therapy

Journal Article

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0000-0002-8532-7891

10.1007/s00392-023-02349-3

Mineralocorticoid receptor antagonists (MRAs) have emerged as potential therapy to target the underlying arrhythmogenic substrate in atrial fibrillation (AF). Nevertheless, there have been inconsistent results on the impact of MRAs on AF. We sought to evaluate the effect of MRAs on AF incidence and progression in patients with and without heart failure. Electronic databases were searched up to September, 2022 for randomized controlled trials (RCTs) that evaluated MRA use and reported AF outcomes. Primary outcome was a composite of new-onset or recurrent AF. Safety outcomes included hyperkalemia and gynecomastia risks. A random-effects meta-analysis estimated pooled odds ratios (OR) and 95% confidence intervals (CI). 12 RCTs, comprising 11,419 patients treated with various MRAs were included [5960 (52%) on MRA]. On follow-up (6-39 months), 714 (5.5%) patients developed AF. MRA therapy was associated with a 32% reduction in the risk of new-onset or recurrent AF [OR 0.68 (95% CI 0.51-0.92), I2 = 40%]. On subgroup analysis, the greatest benefit magnitude was demonstrated in reducing AF recurrence [OR 0.50 (95% CI 0.30-0.83)] and among patients with left ventricular dysfunction [OR 0.59 (95% CI 0.40-0.85)]. Gynecomastia, but not hyperkalemia, was associated with MRA use. Meta-regression analysis demonstrated that therapy duration was a significant interaction factor driving the effect size (Pinteraction = 0.013). MRA use is associated with a reduction in AF risk, especially AF progression. A prominent effect is seen in patients with heart failure, further augmented by therapy duration. Prospective trials are warranted to evaluate MRA use as upstream therapy for preventing this common arrhythmia.

link

Clinical Research in Cardiology : Official Journal of the German Cardiac Society 2024-01-03

Clinical Research in Cardiology : Official Journal of the German Cardiac Society

1861-0692