Reduction in Life-Threatening Ventricular Tachyarrhythmias in Statin-Treated Patients With Nonischemic Cardiomyopathy Enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy)

Study Questions:

Do statins prevent ventricular tachycardia (VT) in patients with nonischemic cardiomyopathy (NICM)?

Methods:

This was a post-hoc analysis of a randomized trial of implantable cardioverter defibrillators (ICD) versus ICDs plus cardiac resynchronization therapy for primary prevention of sudden death in patients with an ejection fraction 30% and QRS duration >130 ms. The subjects of the present study were 821 patients with NICM. The primary endpoint of the study was death or ICD therapy for VT or ventricular fibrillation (VF). Patients receiving a statin (n = 499) were compared to patients not receiving a statin (n = 322).

Results:

Time-dependent statin therapy was independently associated with a significant 77% reduction in the risk of fast VT/VF or death (p < 0.001) and significant 46% reduction in the risk of appropriate ICD shocks (p = 0.01). The cumulative probability of fast VT/VF or death at 4 years of follow-up was significantly lower among statin-treated patients (11%) compared with patients not treated with statins (19%; p = 0.006 for the overall difference during follow-up).

Conclusions:

The authors concluded that statins prevent VT/VF in patients with NICM.

Perspective:

Prior studies demonstrating an antiarrhythmic effect of statins were performed mostly in patients with coronary artery disease. The present study, although nonrandomized, provides evidence that the antiarrhythmic effect of statins in patients at risk of lethal ventricular arrhythmias is mediated by mechanisms other than prevention of ischemic events. The possible mechanisms by which statins prevent VT/VF include an anti-inflammatory effect, modulation of ion channel function, a beneficial effect on autonomic tone, and a reduction in QT dispersion.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Risk, Coronary Artery Disease, Defibrillators, Follow-Up Studies, Death, Cardiomyopathies, Ventricular Fibrillation, Cardiac Resynchronization Therapy, Tachycardia


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