Atrial Fibrillation in Primary Aldosteronism

Chien-Ting Pan; Cheng-Hsuan Tsai; Zheng-Wei Chen; Yi-Yao Chang; Vin-Cent Wu; Chi-Sheng Hung; Yen-Hung Lin; the TAIPAI Study Group

doi:10.1055/a-1141-5989

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2020; 52(06): 357-365
DOI: 10.1055/a-1141-5989

Review

Atrial Fibrillation in Primary Aldosteronism

Authors

Chien-Ting Pan

¹Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan

²Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Cheng-Hsuan Tsai

²Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

³Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
Zheng-Wei Chen

¹Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan

²Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Yi-Yao Chang

⁴Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
Vin-Cent Wu

⁵Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Chi-Sheng Hung

²Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

⁶Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
Yen-Hung Lin

²Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

⁶Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan

the TAIPAI Study Group

Abstract

Primary aldosteronism (PA) is the most common cause of secondary hypertension. Increasing evidence has demonstrated an increased cardiovascular risk in patients with PA compared to those with essential hypertension (EH), including atrial fibrillation (AF), the most prevalent arrhythmia among adults that is associated with an elevated risk of subsequent cerebro-cardiovascular adverse events. The mechanisms of increased prevalence of AF in PA patients are complex. Excessive aldosterone production is regarded to be a key component in the pathogenesis of AF, in addition to arterial hypertension and electrolyte imbalance. In addition, several translational and clinical studies have reported that structural remodeling with atrial fibrosis and electrical remodeling with arrhythmogenicity induced by an excess of aldosterone also play major roles in AF genesis. Clinical studies from several registries and meta-analysis have reported an increased prevalence and risk of AF in PA patients compared to EH patients. Recent trials have further demonstrated a reduction in the risk of new-onset atrial fibrillation (NOAF) after adrenalectomy, while the results of medical treatment with mineralocorticoid receptor antagonists (MRAs) have been inconsistent. This review outlines the current evidence of the relationship between PA and AF, and highlights recent progress in the management of PA with regards to the development of AF.

Key words

atrial fibrillation - primary aldosteronism - aldosterone - atrial remodeling

Full Text

References

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