Journal Scan Summary
Eplerenone and Atrial Fibrillation in Mild Systolic Heart Failure: Results From the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure) Study
April 23, 2012
Swedberg K, Zannad F, McMurray JJ, et al., on behalf of the EMPHASIS-HF Study Investigators.
J Am Coll Cardiol 2012;59:1598-1603.
Does eplerenone prevent atrial fibrillation/flutter (AF/Fl) when added to an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB)?
Patients (mean age 69 years) with New York Heart Association functional class II heart failure (HF) and an ejection fraction <35% who were being treated with an ACEI or ARB were randomly assigned to treatment with eplerenone (n = 1,364) or a matching placebo (n = 1,373). The study endpoint was new-onset AF/Fl.
Thirty-four percent of patients had AF/Fl at baseline. New-onset AF/Fl occurred during the study period significantly less often in the eplerenone group (2.7%) than in the placebo group (4.5%). Eplerenone significantly reduced the risk of cardiovascular mortality and HF hospitalization by approximately 35% regardless of whether or not AF/Fl was present at baseline.
The authors concluded that eplerenone reduces the risk of new-onset AF/Fl in patients with mild HF by approximately 40%.
Activation of the renin-angiotensin-aldosterone system in HF promotes atrial fibrosis and remodeling, which contribute to the pathogenesis of AF/Fl. ACEIs and ARBs initially were thought to prevent AF/Fl by causing reverse remodeling, but this has not been borne out in large randomized clinical trials. Eplerenone is a mineralocorticoid antagonist (MRA) and has been shown to attenuate structural remodeling in animal models. This may explain why eplerenone reduced the risk of AF/Fl in the present study.
Fred Morady, M.D., F.A.C.C. (Disclosure)
Heart Failure/Transplant, Arrhythmias, Afib, Cardiac Rhythm Management, Prevention/Vascular