Statins flop in reducing risk of conduction disturbances and arrhythmias after TAVR

Alexandra J. Lansky, Yale School of Medicine, New Haven, CT, United States of America, and colleagues revealed that statins do not appear to reduce the risk of post-TAVR atrial fibrillation or conduction abnormalities.

Post-TAVR conduction disturbances and atrial fibrillation are reported to be associated with markedly worse short- and long-term prognoses. Statins have multiple pleiotropic effects that may be beneficial in the periprocedural periods of cardiac interventions. They have anti-inflammatory, antioxidant, and antithrombotic effects, can reduce sympathetic activity, and may down-regulate the renin-angiotensin system. It has been hypothesized that statins may protect against incident AF or conduction disturbance.

To determine the effect of antecedent statin usage on arrhythmias and conduction disturbances after TAVR, the research team retrospectively collected data on consecutive patients in the Yale New Haven Health TAVR Registry. It included patients who did not have a prior pacemaker, had at least 1 pre- and post-TAVR electrocardiogram, and did not have a change to their statin regimen during the index hospitalization.

The primary endpoint of the study was the composite of new pacemaker placement, other new conduction disturbances, and new AF evaluated at seven days post-TAVR.

The study revealed the following findings:

• 612 patients met the inclusion criteria between 2012 and 2019. Of these, 162 patients were not on antecedent statins, and 450 were (28 low-intensity, 225 moderate-intensity, and 197 high-intensity).
• After 1:1 propensity matching, 99 patients on moderate-/high-intensity statins were matched to 99 patients not on antecedent statins.
• At 7 days, there was no significant difference in the occurrence of the primary endpoint (57 % statin users versus 46 % non-statin users).
• There was a trend toward increased conduction disturbances 7 days after TAVR in statin users (56 % versus 42 %), but rates of AF (5 % versus 8 %) and pacemaker placement (9 % versus 15 %) were numerically lower in statin users.
• There was no significant difference in persistent conduction disturbances (21 % versus 18 %).

“The study did not find a significant benefit of statin use on post-TAVR conduction disturbances, incident AF, or permanent pacemaker (PPM placement), however, its power to detect differences in individual endpoints was limited,” the researchers wrote.

“Further studies are needed to identify if statins or other medications change the incidence of these complications,” they concluded.

Reference:

Shah, T., Maarek, R., See, C., Huang, H., Wang, Y., Parise, H., Forrest, J. K., & Lansky, A. J. (2024). Effect of antecedent statin usage on conduction disturbances and arrhythmias after transcatheter aortic valve replacement. Cardiovascular Revascularization Medicine, 59, 3-8. https://doi.org/10.1016/j.carrev.2023.07.022