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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]

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Most Read Articles
22 Oct 2017
Drinking coffee, whether caffeinated or decaffeinated, is associated with a reduced risk of cardiovascular disease (CVD) and ischaemic heart disease (IHD) mortality in patients with a prior myocardial infarction (MI), according to a recent study.
23 Sep 2018
Supplementation with n−3 or omega-3 fatty acids does not help prevent serious vascular events in diabetic patients without evidence of cardiovascular disease at baseline, according to a study.
Roshini Claire Anthony, 11 Oct 2018

The risk of hospitalization due to heart failure was almost halved in patients with secondary mitral regurgitation who underwent transcatheter mitral valve repair plus medical therapy compared with those who underwent medical therapy alone, according to findings of the COAPT* trial.

07 Jan 2016

According to a Cochrane review, there is moderate evidence to show that fibrates can prevent myocardial infarction (MI) in patients with existing circulatory disease. [2015;10:CD009580. Doi:10.1002/14651858.CD009580.pub2]