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The role of hyperaldosteronemia in recurrent atrial fibrillation

Vatutin N. T.1, Shevelyok A. N.1, Kravchenko I. N.2
1 – “M. Gorky Donetsk National Medical University” of the Ukraine Ministry of Health Care, Prospekt Iljicha 16, Donetsk 83003, Ukraine
2 – State Institution, “V. K. Gusak Institute of Urgent and Reconstructive Surgery of the Ukrainian National Academy of Medical Sciences”, Leninskij Prospekt 47, Donetsk 83045, Ukraine

Keywords: aldosterone, hyperaldosteronism, relapses of atrial fibrillation, prognosis, risk

DOI: 10.18087/rhj.2016.3.2128

Background. Hyperactivation of the RAAS plays a key role in structural remodeling of the myocardium, which underlies atrial fibrillation (AF). However, the role of excessive aldosterone production in AF relapses is unknown. Aim. To analyze changes in the level of blood aldosterone during AF attacks and after recovery of the sinus rhythm. Materials and methods. The study included 46 patients (24 males and 12 females, mean age 59.6±6.2) with recurrent nonvalvular AF. Serum aldosterone was measured using the immunoenzyme method twice, during an AF attack and at 24–48 h of heart rhythm (HR) recovery. After that patients were followed up for 3 months, and AF relapses were recorded. Results. 14 (30 %) patients had AF relapses (group 1); the remaining 32 (70 %) preserved the HR (group 2). The initial level of plasma aldosterone measured during an arrhythmia attack did not significantly differ between groups 1 and 2 (312.4±19.4 and 286.3±22.6 pg / ml, respectively (р=0.072). After successful cardioversion, the hormone concentration significantly decreased only in group 2 (to 184.2±13.6 pg / ml; р<0.001) whereas in group 1, the decrease did not reach a statistical significance (289.4±18.4 pg / ml; р=0.07). The absence of 25 % decrease in aldosterone level within 24 h of HR recovery was a predictor for recurrent arrhythmia (OR, 2.42; 95 % CI, 1.86–4.06, р=0.01). Conclusion. In patients with recurrent AF, blood concentration of aldosterone increased during arrhythmia and decreased at 24–48 h of HR recovery. The absence of 25 % decrease in aldosterone following successful cardioversion was a predictor for recurrent arrhythmia in the next 3 months.
  1. Шевелёк А. Н. Влияние омега-3 полиненасыщенных жирных кислот на биоэлектрическую активность сердца у пациентов с пароксизмальной фибрилляцией предсердий. Украинский кардиологический журнал. 2014;2:93–8 [Shevelyok A. N. Vliyanie omega-3 polinenasy`shhenny`x zhirny`x kislot na bioe`lektricheskuyu aktivnost` serdcza u paczientov s paroksizmal`noj fibrillyacziej predserdij. Ukrainskij kardiologicheskij zhurnal. 2014;2:93–8].
  2. Goette A, Hoffmanns P, Enayati W, Meltendorf U, Geller JC, Klein HU. Effect of successful electrical cardioversion on serum aldosterone in patients with persistent atrial fibrillation. Am J Cardiol. 2001 Oct 15;88 (8):906–9.
  3. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005 Dec;18 (12):1440–63.
  4. Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005 Apr 19;45 (8):1243–8.
  5. Zhao J, Li J, Li Y, Li W, Shan H, Gong Y, Yang B. Effects of spironolactone on atrial structural remodeling in a canine model of atrial fibrillation produced by prolonged atrial pacing. Br J Pharmacol. 2010 Apr;159 (8):1584–94.
  6. Reil JC, Hohl M, Selejan S, Lipp P, Drautz F, Kazakow A et al. Aldosterone promotes atrial fibrillation. Eur Heart J. 2012 Aug;33 (16):2098–108.
  7. Qian Y, Liu Y, Tang H, Zhou W, Jiang L, Li Y et al. Circulating and local renin-angiotensin-aldosteron system express differently in atrial fibrillation patients with different types of mitral valvular disease. J Renin Angiotensin Aldosterone Syst. 2013 Sep;14 (3):204–11.
  8. Ватутин Н. Т., Шевелёк А. Н., Дегтярева А. Э., Касем С. С. Роль гиперальдостеронизма и перспективы применения антагонистов альдостерона при резистентной артериальной гипертензии (обзор литературы). Журнал Национальной академии медицинских наук Украины. 2014;20 (1):43–51. [Vatutin N. T., Shevelyok A. N., Degtyareva A. E`., Kasem S. S. Rol` giperal`dosteronizma i perspektivy` primeneniya antagonistov al`dosterona pri rezistentnoj arterial`noj gipertenzii (obzor literatury`). Zhurnal Naczional`noj akademii mediczinskix nauk Ukrainy`. 2014;20 (1):43–51.]
  9. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986 Feb 15;57 (6):450–8.
Vatutin N. T., Shevelyok A. N., Kravchenko I. N. The role of hyperaldosteronemia in recurrent atrial fibrillation. Russian Heart Journal. 2016;15 (3):161–165

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