Effect of Esaxerenone in Patients With Persistent Atrial Fibrillation and Hypertension After Catheter Ablation

Background In this study, we investigated the effects of esaxerenone, a nonsteroidal mineralocorticoid receptor antagonist, in patients with persistent atrial fibrillation (AF) and hypertension after they had undergone catheter ablation. Methodology Our retrospective analysis included 157 consecutive patients with this condition. Overall, 40 patients received esaxerenone within three months after catheter ablation (hereafter, the esaxerenone group), and 117 of them did not (hereafter, the non-esaxerenone group). Other conventional pharmacologic agents were used similarly in the two groups. Results The rate of freedom from AF at one year was not significantly different between the two groups (80% (n = 32) vs. 84% (n = 98), p = 0.60). Independent predictors for AF recurrence according to univariate and multivariate Cox regression analysis were the duration of AF history (p < 0.01) and left ventricular myocardial index (LVMI) before ablation (p < 0.01). There was no significant difference in brain natriuretic peptide or LVMI before ablation (p = 0.43 and 0.89) between the groups. However, the esaxerenone group showed lower levels of brain natriuretic peptide at six months after catheter ablation (50.0 (16.3, 83.9) vs. 64.6 (25.9, 132.0) ng/mL, p = 0.02) and significant decrease in LVMI at one year after catheter ablation (-3.8 (-21.7, 3.5) vs. 0.0 (-4.3, 9.9) g/m², p < 0.01) compared with the non-esaxerenone group. Conclusions Esaxerenone did not suppress the recurrence of AF in our cohort of patients with persistent AF and hypertension after catheter ablation. However, we suggest that esaxerenone is cardioprotective by reducing brain natriuretic peptide levels and LVMI.