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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
Elaine Soliven, 27 Nov 2019
High levels of trunk fat mass (FM) may be associated with an increased risk of cardiovascular disease (CVD)-related events such as coronary death, nonfatal myocardial infarction, or coronary heart disease in postmenopausal women with normal body mass index (BMI), according to a recent study presented at AHA 2019.
28 Nov 2019
Slideshow: Highlights from the American Heart Association (AHA) Scientific Sessions 2019
28 Oct 2019
The C-reactive protein (CRP)-to-albumin ratio (CAR) appears to be linked to the development of acute kidney injury in patients with ST elevation myocardial infarction (STEMI), a recent study has found.
28 Nov 2019
The addition of evolocumab to high-intensity statin therapy is both well tolerated and effective in significantly reducing low-density lipoprotein cholesterol (LDL-C) levels in patients hospitalized for acute coronary syndromes (ACS), allowing most of them to achieve current recommended target levels, a study has shown.