CLINICAL ASPECTS AMT, v. II, no. 3, 2014, p. 203 SPIRONOLACTONE ADDED-ON STANDARD ANTIARRHYTHMIC PHARMACOLOGICAL THERAPY DECREASES THE ATRIAL FIBRILLATION RECURRENCES ADRIAN TASE 1 , MIHAI POPESCU 2 , MONICA ŢÂNŢU 3 1,2 Emergency Hospital Argeş, University of Piteşti, 3 University of Piteşti Keywords: spironolactone, antiarrhythmics, atrial fibrillation recurrences Abstract: The alterations of atrial structure induced by the iterative atrial fibrillation (AFib) include renin-angiotensin-aldosterone system (RAAS) overexpression which could have a dominant role, aldosterone being involved in inflammation, fibrosis, remodeling. The objective of our study is the direct comparison of two therapeutic regimens (each one including other three subregimens), in order to assess the benefit of mineralocorticoid receptor blockers with spironolactone (S) in repetitive AFib patients (pts). Method. The study considered retrospectively 1008 pts with AFib during the last seven years, structured into two comparative groups, demographically balanced (slight male and 6 th decade pts predominance, respectively, in both groups). The pts within the first group were treated with antiarrhythmics [Amiodarone (A), Propafenone (P) or Sotalol (So)] + S, while the pts within the comparative group were treated with antiarrhythmics (A, P, So) + exogenous potassium supplement (K + ). We compared the occurrence of AFib episodes 24 months before and, respectively, after the initiation of treatment with S. Among the exclusion criteria we notice the pts previously treated with betablockers (indirect antireninic effect), and ACE-inhibitors or ARB’s (K + suppliers), respectively. Results. In the therapeutic arm with antiarrhythmic + S, the AFib episodes decreased dramatically over two times within the two time intervals taken into consideration. In contrast, within the therapeutic arm with antiarrhythmic + K + , the AFib episodes slightly increased. Conclusions. According to our results, S seems to be a valuable additional therapeutic tool in prevention AFib recurrences. Beyond, S reduces RAAS activity and could also reduce the fibrosis involved in structural remodelling. These beneficial effects were independent of blood pressure lowering and are probably connected to the antiinflammatory effects of S. Cuvinte cheie: spironolactonă, antiaritmice, recurenţe de fibrilaţie atrială Rezumat: Alterările atriale structurale induse de fibrilaţia atrială (FibA) iterativă includ hiperfuncţia sistemului renină-angiotensină-aldosteron (SRAA) care poate avea un rol decisiv, aldosteronul fiind implicat în inflamaţie, fibroză, remodelare. Obiectivul studiului nostru a fost compararea directă a două regimuri terapeutice (fiecare incluzând alte trei subregimuri), în scopul de a evalua beneficiul blocării receptorilor mineralocorticoizi cu spironolactonă (S) la pacienţii (pts) cu FibA repetitivă. Metodă. Am studiat 1008 pts cu FibA retrospectiv pe ultimii şapte ani, structuraţi în două grupuri comparative, echilibrate demografic (uşoare predominenţe masculină şi, respectiv, decada a VI-a, la ambele grupuri). Pts din primul grup au fost trataţi cu antiaritmice [Amiodaronă (A), Propafenonă (P) sau Sotalol (So)] + S, în timp ce pts din al doilea grup au fost trataţi cu antiaritmice (A, P, So) + supliment exogen de potasiu (K + ). Am comparat episoadele de FibA înregistrate cu 24 luni înainte cu cele înregistrate după iniţierea tratamentului cu S. Printre criteriile de excludere menţionăm pts trataţi anterior cu betablocante (efect antireninic indirect), respectiv IECA şi sartani (ofertanţi de K + ). Rezultate. În braţul terapeutic cu antiaritmic + S, episoadele de FibA au scăzut dramatic de peste două ori în cele două intervale de timp considerate. În contrast, în braţul terapeutic cu antiaritmic + K + , episoadele de FibA au crescut uşor.Concluzii. Potrivit rezultatelor noastre, S pare a fi un instrument terapeutic adi ţional valoros în prevenţia recurenţelor de FibA. În plus, S reduce activitatea SRAA şi ar putea reduce fibroza implicată în remodelarea structurală. Acest efecte benefice au fost independente de presiunea sanguină şi se datorează, probabil, efectelor antiinflamatorii ale S. 1 Corresponding author: Adrian Tase, Aleea Spitalului, Nr. 36, Pitești, România, E-mail: agtase@yahoo.com, Tel: +40248 287150 Article received in 24.06.2014 and accepted for publication on 20.08.2014 ACTA MEDICA TRANSILVANICA September 2014;2(3):203-205 INTRODUCTION Atrial fibrillation (AFib) is such a common arrhythmia that it is often wrongly regarded as an acceptable alternative to normal sinus rhythm. Its first onset may present with rapid and uncomfortable palpitations, breathlessness, dyspnoea, chest pain, and anxiety. Often it is entirely asymptomatic and discovered incidentally. Paroxysmal and persistent recurrences may eventually lapse into permanent AFib. The causes of AFib are multiple and should be identified since many can be corrected, so the management of the arrhythmia can be simplified. The consequences of AFib may be terrible, like heart failure, stroke, sudden death, dilated cardiomyopathy (tachyarrythmic), with markedly reduced exercise capacity and degraded quality of life. Adequate rate control or successful rhythm control in suitable patients (pts), with appropriate thromboprophylaxis are essential. Appropriate and competent management can diminish stroke risk and heart failure occurrence, alleviate symptoms and ameliorate anxiety.