Antiarrhythmic potential of aldosterone antagonists in atrial fibrillation

Upstream therapy is the promising issue in the treatment of atrial fibrillation (AF) especially in patients with arterial hypertension and heart failure. The possible beneficial effects of renin-angiotensin-aldosterone system blockade with ACE-inhibitors and angiotensin receptor antagonists in AF prevention have been demonstrated in experimental and clinical studies. There is growing mass of evidence, from both theoretical and experimental research studies, to suggest that upstream therapy using spironolactone or eplerenone may reduce the deleterious effect of excess aldosterone secretion and further modify the environment of AF including inhibition of atrial muscle fibrosis. It refers to patients with different forms of AF, including chronic AF. Aldosterone antagonists treatment may be a simple and valuable additional option in low-risk, hypertensive and heart failure patients in primary and secondary prevention of refractory paroxysmal and persistent AF. (Cardiol J 2012; 19, 3: 223-229)