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Original Articles: Adult Cardiac

Invited Commentary

Department of Cardiology, Westmead Hospital, Westmead NSW 2145, Australia

(Email: stuartpt{at}yahoo.com).

The study by Kourliouros and colleagues [1] is a thorough and clearly presented retrospective assessment describing the relationship between hydroxy-methylgluteryl-coenzyme A reductase inhibitor (statin) use and postoperative atrial fibrillation. The authors found a significant reduction in postoperative atrial fibrillation in patients taking higher doses of statins at the time of their procedures. This effect was not seen in patients on lower doses of the same agents.

When considering the results of this study it is important to understand the limitations of the methodology. In a retrospective analysis it is difficult to control for baseline differences between the treatment and nontreatment groups. In this study, there were important differences between the patients with and without statins. The statins were more likely to be prescribed for patients with coronary artery disease. Therefore, the underlying heart disease and surgical procedures in the statin group were significantly different than those in the non-statin patients. Furthermore, there may have been differences in unreported variables, such as left atrial size. The authors have used appropriate statistical methods to adjust for these differences, but the results still can not be accepted with the same confidence as those of a randomized trial. The study clearly demonstrates an association between high-dose statin use and a reduction in postoperative atrial fibrillation. However, the conclusion that statins prevented atrial fibrillation is more tenuous, given the methodology used.

The current article should be considered within the context of previous studies examining the role of statins for prevention of atrial fibrillation. These include some observational studies and a single, small randomized study as noted by Kourliouros and colleagues [1] (in Reference 8 of their article). The randomized trial called ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) was well conducted, but there were some unexpected differences in the baseline patient characteristics and a higher than expected incidence of postoperative atrial fibrillation that cast some residual doubt on the conclusions. The current study makes an important contribution by lending weight to these earlier findings and adding more data regarding variations in statin dose and the incidence of postoperative atrial fibrillation.

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1. Kourliouros A, De Souza A, Roberts N, et al. Dose-related effect of statins on atrial fibrillation after cardiac surgery Ann Thorac Surg 2008;85:1515-1520.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Thomas, S. P. Search for Related Content PubMed PubMed Citation Articles by Thomas, S. P. Related Collections Electrophysiology - arrhythmias Related Article