Most Read Articles
Elvira Manzano, 28 Jul 2020
The efficacy and cardiovascular (CV) safety of the SGLT2* inhibitor empagliflozin vs DPP-4** inhibitors and GLP-1*** receptor agonists in real-world patients were demonstrated in two interim analyses of the EMPRISE+ study presented at ADA 2020.
Roshini Claire Anthony, 14 Sep 2020

Patients hospitalized with mild-to-moderate COVID-19 who are on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for hypertension should continue these medications, according to primary results of the BRACE CORONA trial presented at ESC 2020.

Tristan Manalac, 09 Jul 2020
Left ventricular assist devices (LVADs) trigger almost immediate favourable metabolic changes in both diabetics and nondiabetics, according to a recent study.
29 Mar 2020
Targeting a low-density lipoprotein cholesterol level <70 mg/dL following an ischaemic stroke of atherosclerotic origin helps to avoid one in four subsequent major vascular events without increasing the risk of intracranial haemorrhage over about 5 years of follow-up, according to data from the Treat Stroke to Target trial.

Spironolactone protects against ventricular arrhythmia in ICD implanted patients

Jairia Dela Cruz
05 Oct 2018

Treatment with the nonselective aldosterone receptor agonist spironolactone can significantly reduce ventricular arrhythmic events in patients with implantable cardioverter defibrillator (ICD), according to a Thailand study presented at the 23rd ASEAN Federation of Cardiology Congress (AFCC 2018).

“Spironolactone’s beneficial effect on reducing the incidence of ventricular arrhythmia has been proposed earlier. However, there is still not enough firm evidence to prove this hypothesis,” the investigators said.

To address such gap, the investigators prospectively examined the incidence of ventricular arrhythmic events, as well as ICD-related therapies, in 110 patients with left ventricular dysfunction (ejection fraction [LVEF] <50 percent) and New York Heart Association functional class I-III. The patients were implanted with either ICD or cardiac resynchronization therapy (CRT) device.

In the cohort, 48 received spironolactone (mean age 62.25 years; 66.67 percent male) while the remaining 62 did not (mean age 68.87 years; 75.81 percent male). Most patients had existing comorbidities, including diabetes mellitus (34.55 percent), hypertension (60.90 percent) and atrial fibrillation (31.82 percent).

Over a mean follow-up of 6 months, spironolactone produced significant reductions in ventricular arrhythmic events. On Poisson regression analysis, the incidence rate ratios (IRRs) were 0.65 for total episodes (p<0.001), 0.66 for nonsustained ventricular tachycardia (p<0.001) and 0.36 for ventricular tachycardia (p=0.012). [AFCC 2018, abstract P016]

Risk factors for developing ventricular arrhythmic events were LVEF 35 percent, male sex, older age, diabetes mellitus and hypertension.

Meanwhile, the nonselective aldosterone receptor agonist was associated with only a numerical decrease in the incidence of ICD-related therapies. The IRRs were 0.55 for total therapies (p=0.156) and 0.44 for ventricular antitachycardia pacing (p=0.073). A slightly higher rate of ICD shock was found in the spironolactone vs no treatment group, although the difference was not significant (IRR, 2.47; p=0.511).

The present data may have important clinical implications given that “in ICD implanted patients, ventricular arrhythmia leading to device shock results in many deleterious effects such as mortality and heart failure hospitalizations,” the investigators said.

Potential mechanisms by which spironolactone reduces the number of episodes of ventricular arrhythmias involve the drug’s antiarrhythmic actions, which include inhibition of electrical and structural cardiac remodelling, prevention of neurohumoral activation, blood pressure control and electrolyte disturbances stabilization. [Indian Heart J 2012;64:123-127]

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Elvira Manzano, 28 Jul 2020
The efficacy and cardiovascular (CV) safety of the SGLT2* inhibitor empagliflozin vs DPP-4** inhibitors and GLP-1*** receptor agonists in real-world patients were demonstrated in two interim analyses of the EMPRISE+ study presented at ADA 2020.
Roshini Claire Anthony, 14 Sep 2020

Patients hospitalized with mild-to-moderate COVID-19 who are on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for hypertension should continue these medications, according to primary results of the BRACE CORONA trial presented at ESC 2020.

Tristan Manalac, 09 Jul 2020
Left ventricular assist devices (LVADs) trigger almost immediate favourable metabolic changes in both diabetics and nondiabetics, according to a recent study.
29 Mar 2020
Targeting a low-density lipoprotein cholesterol level <70 mg/dL following an ischaemic stroke of atherosclerotic origin helps to avoid one in four subsequent major vascular events without increasing the risk of intracranial haemorrhage over about 5 years of follow-up, according to data from the Treat Stroke to Target trial.