期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 70, 期 23, 页码 2893-2905出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2017.10.014
关键词
aldosterone; atrial dilation; atrial fibrillation progression; fibrosis; upstream therapy
资金
- National Heart, Lung, and Blood Institute, National Institutes of Health/National Heart, Lung, and Blood Institute [HL122352]
- Leducq Foundation Transatlantic Network of Excellence Program on Structural Alterations in the Myocardium and the Substrate for Cardiac Fibrillation
- University of Michigan Health System-Peking University Health Science Center Joint Institute for Translational and Clinical Research
- Uehara Memorial Foundation
- American Heart Association [14POST18220000]
- Martin Escudero Foundation
- Medtronic
- Abbott
BACKGROUND The aldosterone inhibitor eplerenone (EPL) has been shown to reduce the incidence of atrial fibrillation (AF) in patients with systolic heart failure, but the mechanism is unknown. OBJECTIVES This study hypothesized that by reducing atrial dilation and fibrosis in the absence of heart failure, EPL also reduces AF burden and prevents AF perpetuation. METHODS The authors conducted a randomized controlled study in 34 sheep that were atrially tachypaced (13 +/- 1 week). They compared daily oral EPL (n +/- 19) versus sugar pill (SP) treatment (n = 15) from the start of tachypacing. The endpoint was a continuous 7-day stretch of persistent AF (n = 29) or completion of 23 weeks tachypacing (n = 5). RESULTS EPL significantly reduced the rate of left atrial dilation increase during AF progression. Atria from EPL-treated sheep had less smooth muscle actin protein, collagen-III expression, interstitial atrial fibrosis, and cell hypertrophy than SP-treated sheep atria did. However, EPL did not modify the AF-induced increase in the rate of dominant frequency and ion channel densities seen under SP treatment, but rather prolonged the time to persistent AF in 26% of animals. It also reduced the degree of fibrillatory conduction, AF inducibility, and AF burden. CONCLUSIONS In the sheep model, EPL mitigates fibrosis and atrial dilation, modifies AF inducibility and AF complexity, and prolongs the transition to persistent AF in 26% of animals, but it does not prevent AF-induced electrical remodeling or AF persistence. The results highlight structural remodeling as a central upstream target to reduce AF burden, and the need to prevent electrical remodeling to avert AF perpetuation. (C) 2017 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.
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