Actos (Pioglitazone) and Atrial Fibrillation
Actos (pioglitazone) is not contraindicated in patients with atrial fibrillation (AF). In fact, research suggests pioglitazone may have beneficial effects in patients with AF by suppressing atrial remodeling and potentially decreasing the incidence of AF 1.
Relationship Between Pioglitazone and Atrial Fibrillation
- Pioglitazone has been shown to decrease the incidence of atrial fibrillation through suppression of atrial remodeling 1
- In patients with diabetes mellitus and persistent AF, pioglitazone treatment may decrease the progression from persistent AF to permanent AF 2
- Pioglitazone has demonstrated anti-inflammatory properties that may benefit patients with AF, as inflammation is associated with atrial fibrillation 3
Clinical Evidence Supporting Use in AF Patients
- A study in diabetic patients with persistent AF showed that pioglitazone reduced the incidence of progression to permanent AF (30% in pioglitazone group vs. 49% in placebo group) 2
- Pioglitazone improved preservation of sinus rhythm and reduced reablation rates in patients with paroxysmal AF and type 2 diabetes mellitus after catheter ablation 4
- The beneficial effects appear to be related to pioglitazone's ability to lower pro-collagen type I carboxyterminal peptide (PICP) and advanced glycation end products (AGEs) levels 2
Considerations for Heart Failure Patients
While pioglitazone is not contraindicated in AF, caution is warranted in patients with heart failure:
- Pioglitazone has been associated with fluid retention, which may be interpreted as worsening cardiac function 5
- In patients with type 2 diabetes and systolic dysfunction, pioglitazone was associated with a higher incidence of hospitalization for heart failure compared to glyburide, although without worsening cardiac function by echocardiography 5
- Current AF management guidelines do not list thiazolidinediones as contraindicated medications for AF management 6
Management of AF in Patients on Pioglitazone
For patients with AF who are taking pioglitazone:
- Standard rate control strategies should be employed, including beta-blockers or nondihydropyridine calcium channel antagonists as first-line agents 6
- In patients with heart failure with preserved ejection fraction (HFpEF), a beta blocker or nondihydropyridine calcium channel antagonist is recommended for persistent or permanent AF 6
- For patients with heart failure with reduced ejection fraction (HFrEF), digoxin is effective to control resting heart rate 6
- Careful monitoring for signs of fluid retention is important, particularly in patients with pre-existing heart failure 5
Conclusion
Pioglitazone is not contraindicated in patients with atrial fibrillation and may even have beneficial effects on AF progression. However, clinicians should monitor for fluid retention, particularly in patients with heart failure or at risk for heart failure.