Copyright © 2004 by the European Society of Cardiology.
Letter to the Editor
Anti-inflammatory medication for atrial fibrillation
Department of Cardiology, Euroclinic of Athens, 9 Athanasiadou Str, Athens, Greece
* Tel.: +30 210 641 6600; fax: +30 210 681 9779 (E-mail: dkatrits{at}otenet.gr).
We read with great interest the paper by Dernelis and Panaretou1 as well as the editorial by Abdelhadi and colleagues2 on the efficacy of steroids in the prevention of paroxysmal and permanent atrial fibrillation. We do concur with the conclusions of Abdelhadi et al., regarding the potential therapeutic value of anti-inflammatory medication in patients with AF and a high inflammation status as reflected by elevated C-reactive protein levels. However, their statement that "no studies have prospectively evaluated the efficacy of anti-inflammatory therapies to reduce the occurrence of AF in the general population" is not correct. We have provided evidence that carvedilol, a beta-blocker with established antioxidant properties is probably more efficient than bisoprolol in the prevention of AF recurrences in an unselected patient population.3 In our study, 90 patients undergoing cardioversion of persistent AF were randomized to bisoprolol 5–10 mg once daily or carvedilol 12.5–25 mg twice daily. By intention-to-treat analysis, 23 (46%) patients in the bisoprolol group and 17 (32%) patients in the carvedilol group relapsed into AF, during the 1 year of total follow-up period (P=0.486). Patients treated with carvedilol had a 14% (hazard ratio=0.86) lower risk to relapse to AF as compared with patients in the bisoprolol group. Although the result was statistically insignificant (P=0.661) after controlling for patient age, gender, baseline heart rate, and left atrial diameter, there was a clear trend in favour of carvedilol for maintenance of sinus rhythm. Carvedilol is a slightly (approximately 7-fold) beta 1-selective beta-blocker that becomes non-selective at higher doses; in addition, it possesses alpha 1-blocking and antioxidant properties.4 Indeed, part of its reported beneficial effects on ventricular remodelling effects and coronary microcirculation have been attributed to its antioxidant activities.4 The increased efficacy of carvedilol, therefore, compared to conventional beta-blockade, for the prevention of AF is not surprising. The results of Dernelis and Panaretou, as well as our data, advocate evaluation of such a therapeutic approach, i.e., a combination of conventional antiarrhythmic medication with an anti-inflammatory agent, in greater scale clinical trials of patients with paroxysmal atrial fibrillation.
References
- Dernellis J, Panaretou M. Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation Eur Heart J 2004;25:1100-1107.
[Abstract/Free Full Text] - Abdelhadi RH, Chung MK, Van Wagoner DR. New hope for the prevention of recurrent atrial fibrillation Eur Heart J 2004;25:1089-1090.
[Free Full Text] - Katritsis DG, Panagiotakos DB, Karvouni E, et al. Comparison of effectiveness of carvedilol versus bisoprolol for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation Am J Cardiol 2003;92:1116-1119.[CrossRef][Web of Science][Medline]
- Yaoita H, Sakabe A, Maehara K, et al. Different effects of carvedilol, metoprolol, and propranolol on left ventricular remodeling after coronary stenosis or after permanent coronary occlusion in rats Circulation 2002;105:975-980.
[Abstract/Free Full Text]
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