V.P. Ivanov, Т.D. Danilevych Antiarrhythmic efficiency of eplerenon in complex therapy of patients with arterial hypertension and frequent recurrences of atrial fibrillation

The aim – to determine antiarrhythmic efficiency of eplerenone in the complex therapy of patients with arterial hypertension (AH) and frequent recurrences of atrial fibrillation (AF).

Material and methods. 146 patients with AH II stage and frequent recurrences of AF were examined. The age of the patients was from 37 till 86 years. Among them 68 (46.6 %) were males. Permanent antiarrhythmic therapy was prescribed in all patients. The antiarrhythmic efficiency was evaluated by patient-reported frequency of AF attacks and their course. Fixed combinations of perindopril with indapamide and losartan with hydrochlorothiazide were used as a starting antihypertensive therapy. Eplerenone 25 mg daily was added in a number of the patients. All patients were examined by determining serum aldosterone levels and daily ECG monitoring.

Results. Usage of eplerenone during 6 months decreased frequency of recurrences of AF and increased the duration of the period between recurrences (4.8 vs. 3.2 times, P=0.04). Antiarrhythmic effect of eplerenone was accompanied by significant increase of cases with complete elimination of supraventricular premature contractions (SPC) (P<0.001) and AF episodes (p=0.05), significant decrease of daily SPC frequency (P=0.007) and supraventricular paroxysmal tachycardias / atrial flutter episodes (P<0.04), decrease of QT interval dispersion (P<0.04). The probability of complete antiarrhythmic efficacy with additional use of eplerenone was significantly more in case of the adrenal AF (P<0.03). Factors increasing the probability of complete antiarrhythmic efficacy of eplerenone were: daily heart rate > 78 per minute, the ratio of left atrium /right atrium < 1.45, using of losartan in a dose of 100 mg/day, the dynamics of systolic blood pressure (BP) at the 4th week of treatment according to data of office measurement of BP > 32 mm Hg, and plasma level of aldosterone > 150 pg/ml.

Conclusions. Eplerenone provided additional antiarrhythmic effect in patients with AH and paroxysmal AF. Positive antiarrhythmic effect of eplerenone accompanied by a significant increase in cases with a complete elimination of SPC and AF episodes, significant decrease in the frequency of SPC for the day and SVPT/AF episodes, decrease in the dispersion of QT interval. The probability of complete antiarrhythmic efficacy with additional use of eplerenone significantly increases in the case of adrenal variant and decreases in the case of vagal varian of AF. As factors that increase the probability of complete antiarrhythmic efficacy of eplerenone are: daily HR > 78, the ratio LA/RA < 1.45, using of losartan in a dose of 100 mg/day, the dynamic of systolic BP at the 4th week of treatment according to data of office measurement of BP > 32 mm hg and plasma level of aldosterone > 150 pg/ml.

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