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03-01-2024 | Atrial Fibrillation | Original Paper

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

Authors: Thalys Sampaio Rodrigues, Levindo Jose Garcia Quarto, Savio Carvalho Nogueira, Anoop N. Koshy, Rajiv Mahajan, Prashanthan Sanders, Elif I. Ekinci, Louise M. Burrell, Omar Farouque, Han S. Lim

Published in: Clinical Research in Cardiology | Issue 6/2024

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Abstract

Background

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.

Objective

We sought to evaluate the effect of MRAs on AF incidence and progression in patients with and without heart failure.

Methods

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).

Results

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).

Conclusion

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.

Graphical abstract

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Metadata
Title
Incidence and progression of atrial fibrillation in patients with and without heart failure using mineralocorticoid receptor antagonists: a meta-analysis
Authors
Thalys Sampaio Rodrigues
Levindo Jose Garcia Quarto
Savio Carvalho Nogueira
Anoop N. Koshy
Rajiv Mahajan
Prashanthan Sanders
Elif I. Ekinci
Louise M. Burrell
Omar Farouque
Han S. Lim
Publication date
03-01-2024
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 6/2024
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-023-02349-3

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