Atrial fibrillation in primary aldosteronism

Introduction. Primary aldosteronism (PA) is caused by autonomous hypersecretion of aldosterone from the adrenal cortex, classically from an adenoma, resulting in sodium and water retention, hypokalaemia and raised blood pressure. The sodium and water retention causes suppression of renin release. The possible cardiac sequelae of aldosterone excess are encountered primarily in patients with secondary hyperaldosteronism due to heart failure, where plasma renin, angiotensin and aldosterone levels are all raised. However, there is also evidence that primary aldosterone excess, in the presence of low renin levels, may also be cardiotoxic.

Patients. In this report, we describe five patients with PA, who developed atrial fibrillation (AF) in the absence of structural cardiac lesions and in one case despite good control of blood pressure and electrolytes.

Conclusion. In patients with hypertension and AF, who have no evidence of coronary disease or any other underlying cause of AF with preserved systolic function, a diagnosis of PA should be considered.