Arrhythmias & electrophysiologySecondary analysis
Increasing plasma potassium and risk of atrial fibrillation: the POTCAST trial
- Prespecified analysis of the POTCAST randomised trial
Authors' conclusion
In adults with any cardiac disease, treated with an ICD or CRT-D, uptitration of plasma potassium levels within the normal range reduced the risk of atrial fibrillation-related clinical events.
Study context
- Population
- Adults with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) and plasma potassium ≤4.3 mmol/L
- Participants
- 1,200 adults
- Comparison
- Potassium-increasing treatment + standard care vs standard care alone
- High-normal potassiumn = 600
- Controln = 600reference
- Primary endpoint
- Composite of:
- Acute hospitalizations due to AF leading to a change in pharmacological treatment or due to inappropriate shock therapy
- Hospitalization for electrical cardioversion or ablation of AF
- Loading with amiodarone for AF (death as competing risk)
- Follow-up
- median follow-up 3.3 person-years
Primary result
As reported in the abstract
Subdistribution hazard ratio
.65
95% CI .45-.93
P = 0.02
Events by treatment group
Further findings
| Outcome | increase (mmol/L) |
|---|---|
| Plasma potassium after uptitration | .3 |
Primary endpoint by subgroup, incl. with vs without history of AF
- Treatment effect appeared similar across subgroups
Original publication
Increasing plasma potassium and risk of atrial fibrillation: the POTCAST trial. Eur Heart J. Published 30 August 2026. doi:10.1093/eurheartj/ehag436
Summarised from the published abstract; every number is checked against it