Statin in prevention of atrial fibrillation after cardiac surgery

Zen, Bárbara; Rossi, Luiza; Rosa, Eduardo Maffini da

doi:10.1590/S0066-782X2011000600014

LETTER TO THE EDITOR

Universidade de Caxias do Sul - UCS, Caxias do Sul, RS - Brazil

Mailing address

Keywords: Hydroxymethylglutaril-CoA reductase inhibitors/therapeutic use; atrial fibrillation/prevention & control; postoperative period.

Our group of studies on coronary heart diseases would like to congratulate the authors for the article by Alves et al¹ for this relevant subject matter. We wished to report our opinion regarding the chronic use of preoperative statin and atrial fibrillation in the postoperative period.

The onset of atrial fibrillation often occurs in patients after cardiac surgery². And the presence of three or more risk factors significantly increases the incidence of arrhythmia after cardiac surgery³.

We agree with the existence of an anti-inflammatory effect attributed to statins, but we believe that reducing the occurrence of atrial fibrillation in the postoperative period is due to a smaller manipulation of the pericardium in patients taking statins, due to a greater stabilization of atherosclerotic ischemia and smaller extension of coronary disease. Postoperative atrial fibrillation has a strong relationship with the degree of pericardial inflammation, which is turn related to the amount of pericardial manipulation.

We would like to ask the authors about the occurrence of acute postoperative pericarditis and the occurrence of atrial fibrillation in this group.

Reply

We greatly appreciate your attention and we are honored with the comments made to our study, which will serve as an encouragement, and for future observations.

Undoubtedly, pericarditis is a risk factor for developing atrial fibrillation after cardiac surgery, as well as the presence of three or more risk factors^1,2. Therefore, we have already included this risk factor in our current research.

However, in the study at hand³, there was no clinical sign of acute pericarditis in the postoperative period. We have observed in patients only the presence of pericardial friction between the immediate postoperative period and the first day after the surgery. This picture was spontaneously solved and we did not associate it with the onset of atrial fibrillation.

Sincerely,

Dr. Renato J. Alves

References

Referências (Respostas)

1. Alves RJ, Campos RN, Nakiri K. Chronic and regular use of statin prevents atrial fibrillation in period after cardiac surgery. Arq Bras Cardiol. 2010;95(5):614-20.
2. Bradley D, Creswell LL, Hogue CW Jr, Epstein AE, Prystowsky EN, Daoud EG / (American College of Chest Physicians). Pharmacologic prophylaxis: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest. 2005;128(2 Suppl.):39-47.
3. Geovanini GR, Alves RJ, Brito G, Miguel AS, Glauser VA, Nakiri K. Fibrilação atrial no pós-operatório de cirurgia cardíaca: quem deve receber quimioprofilaxia? Arq Bras Cardiol. 2009;92(4):326-30.
1. Alves RJ, Geovannini GR, Brito G, Miguel GAS, Glauser VA, Nakiri K. Amiodarona em moderada dosagem previne fibrilação atrial aguda em pacientes com fatores de risco arritmogênicos no pós-operatório de cirurgia cardíaca. Arq Bras Cardiol. 2007;89(1):22-7.