Time-Dependent Risk of Atrial Fibrillation in Patients With Primary Aldosteronism After Medical or Surgical Treatment Initiation

Increased risk of atrial fibrillation was reported in patients with primary aldosteronism. However, data are limited regarding the time-dependent risk of atrial fibrillation in surgically or medically treated primary aldosteronism. From the National Health Insurance Claim database in Korea (2003-2017), a total of 1418 patients with primary aldosteronism (adrenalectomy [ADX], n=755, mineralocorticoid receptor antagonist n=663) were age- and sex-matched at a 1:5 ratios to patients with essential hypertension (n=7090). Crude incidence of new onset atrial fibrillation was 2.96% in primary aldosteronism and 1.97% in essential hypertension. Because of nonproportional hazard observed in new onset atrial fibrillation, analysis time was split at 3 years. Compared with essential hypertension, risk of new onset atrial fibrillation peaked at 1 year gradually declined but remained elevated up to 3 years in overall treated primary aldosteronism (adjusted hazard ratio [aHR] 3.02; P<0.001) as well as in both ADX (aHR, 3.54; P<0.001) and mineralocorticoid receptor antagonist groups (aHR 2.27; P=0.031), which became comparable to essential hypertension afterward in both groups (ADX aHR, 0.38; P=0.102; mineralocorticoid receptor antagonist aHR, 0.60; P=0.214). Nonetheless, mineralocorticoid receptor antagonist group was associated with increased risk of nonfatal stroke (aHR, 1.21; P=0.031) compared with essential hypertension, whereas ADX was not (aHR, 1.26; P=0.288). Our results suggest the risk of new-onset atrial fibrillation remained elevated up to 3 years in treated primary aldosteronism compared with essential hypertension, which declined to comparable risk in essential hypertension thereafter. Monitoring for atrial fibrillation up to 3 years after treatment, particularly ADX, might be warranted.

Automated summary

The risk of new-onset atrial fibrillation remains elevated up to 3 years in patients with primary aldosteronism compared with essential hypertension, especially peaking at 1 year, and gradually declining afterwards to levels comparable with essential hypertension. Monitoring for atrial fibrillation up to 3 years after treatment, particularly in patients who underwent adrenalectomy, may be necessary.