Background: The alterations of atrial structure induced by the repetitive atrial fibrillation (AFib) includes renin-angiotensin-aldosterone system (RAAS) overexpression which could have a decisive role, aldosterone being involved in inflammation, fibrosis, remodeling.
The aim of our study is the direct comparison of two therapeutic regimens (each one including other three subregimens), in order to assess the benefit of spironolactone (Sp) in repetitive AFib patients (pts).
Method: The study considered 1008 pts with AFib, starting with 1st Nov 2007, structured into two comparative groups, demographically balanced (slight male and 6th decade pts predominance, respectively in both groups). The pts within the first group were treated with antiarrhythmics {Amiodarone (A) 68,85% (347 pts) or Propafenone (P) 22,22% (112 pts) or Sotalol (S) 8,93% (45 pts)} + exogenous potassium supplement (K+), while the pts within the second group were treated with antiarrhythmics {A 68,85% (347 pts) or P 22,22% (112 pts) or S 8,93% (45 pts)} + Sp. We compared the occurrence of AFib episodes 24 months before and, respectively, after the initiation of treatment with Sp. Two exclusion criteria referred to the pts previously treated with betablockers (indirect antireninic effect), and ACE-inhibitors or ARB’s (K+ suppliers), respectively.
Results: The adjacent table structures the main outcomes of the study:
Conclusions: Sp appears in our pts as a valuable additional therapeutic tool in decreasing AFib recurrences. Sp brings an endogenous potassium, more metabolic friendly than K+ exogenic uptake. Beyond, it reduces RAAS activity and could also reduce the fibrosis involved in structural remodeling. These beneficial effects were independent of BP lowering and are probably due to the antiinflammatory effects of Sp.
