Effect Of Rosuvastatin On Prevention Of Atrial Fibrillation Following Dual-chamber Pacemaker Implantation In Patients With Sick Sinus Syndrome

Background:Sick sinus syndrome(SSS) is a common clinical arrhythmia, the only way to solve it is cardiac pacing. Clinical follow-up studies found that the majority of patients with SSS would suffer from atrial high rate episodes(AHREs) or atrial fibrillation(AF) after dual-chamber pacemaker implantation. AF not only damages the normal operation of pacemaker but also induces stroke, heart failure and myocardial injury, which seriously affect the quality of patients'life and even endanger the patients' lives. Therefore, it is important to prevent and reduce AF occurrence after pacemaker implantation. The effectiveness of anti-arrhythmic drugs against AF is not high at the present stage, and their side effects are significant in long-turm use, so their "net effects" are very limited. In recent years, statins have been gradually recognized about their roles of anti-AF. However, the related evidences are insufficient. Further studies are still needed to confirm their effectiveness and safety, so as to guide the selection for clinical medication of AF.Objective:To observe AF onset and progress as well as the changes in cardiac structure and function in SSS patients taking rosuvastatin when they suffer from paroxysmal AF after dual-chamber pacemaker implantation, while observing the impact of rosuvastatin on liver and muscle.Subjects and methods:103 SSS patients with paroxysmal AF recurrence and occurrence following dual-chamber pacemaker insertion were randomized to the statin group(n=52) and the control group(n=51). On the basis of the treatment of original diseases, the statin group were given rosuvastatin,10 mg served every night, the control group were not given any statins. AF times, AF duration, percentages of atrial pacing(AP) and ventricular pacing(VP) were monitored by pacemaker records every 3 months up to 12 months after randomization. Then AF burden(h/d) and incidence of persistent AF(AF episodes lasting≥48 h) were summarized during 12 months. Before and 12th month after randomization, left atrial diameter(LAD) and left ventricular ejection fraction(LVEF) were measured by Doppler echocardiography; at the same time, total cholesterol(TC), low-density lipoprotein cholesterol(LDL), alanine aminotransferase(ALT), aspartate aminotransferase(AST) and creatine kinase(CK) were also collected by fasting blood early morning. The above-mentioned indicators were compared between the two groups over the same period as well as before and after treatment in the same group.Results:3 patients withdrew from the study because of taking amiodarone during the follow-up period, and 51 cases in the statin group,49 cases in the control group actually completed the regular follow-up. After follow-up of 12 months, AF burden was significantly lower in patients receiving statin therapy when compared with those not receiving statin therapy(0.136±0.119 h/d vs 0.333±0.192 h/d, P<0.05). Additionally, the incidence of persistent AF in the control group was higher than that in the statin group (6/49 vs 1/51, P<0.05). At the end of study, LAD was smaller (35.8±2.7 mm vs 40.5±3.5 mm, P<0.01), serum levels of blood lipid (TC, LDL) were lower (3.44±0.70 mmol/L vs 4.47±0.87 mmol/L,1.95±0.20 mmol/L vs 2.75±0.75 mmol/L, both P <0.01) in the statin group. There was no significant differences in cardiac function(LVEF), liver function (ALT, AST) and CK (65.00±6.29% vs 62.10±6.49%, 25.50±15.34 U/L vs 26.50±13.13 U/L,27.30±11.65 U/L vs 28.20±9.25 U/L,89.70±48.13 U/L vs 89.60±54.72 U/L, all P>0.10) between the two groups. AF burden, LAD, TC and LDL were significantly lower after treatment than those before treatment in the statin group; LVEF, ALT, AST and CK didn't chang obviously after treatment in the statin group. There was no significant differences in the above-mentioned indicators before and after treatment in the control group. There was no significant differences in the percentage of AP and VP before and after treatment between the two groups. Serious liver damage or myopathy was not found in the two groups during the follow-up period.Conclusion:Rosuvastatin can effectively inhibit the occurrence and progress of paroxysmal AF after dual-chamber pacemaker implantation in patients with SSS, meanwhile reversing the left atrial structural remodeling. Patients can well tolerate the conventional dose of rosuvastatin, and can't have serious liver or muscle damage with such dose.