Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Risk of Atrial Fibrillation before Coronary Artery Bypass Grafting

K, Johnston; Stephens, Sarah

doi:10.1345/aph.1r128

Cited by 7 publications

(3 citation statements)

References 11 publications

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“…18, 27–29 Studies in adult populations following coronary artery bypass grafting have yielded conflicting results with respect to the utility of preoperative angiotensin converting enzyme inhibition and reduction in the incidence of postoperative atrial fibrillation. 30–33 To our knowledge, no series to date has evaluated for a potential association between preoperative ACE inhibition and postoperative tachyarrhythmias in children.…”

Section: Discussionmentioning

confidence: 99%

A common angiotensin-converting enzyme polymorphism and preoperative angiotensin-converting enzyme inhibition modify risk of tachyarrhythmias after congenital heart surgery

et al. 2014

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Background The angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism is described in association with numerous phenotypes including arrhythmias, and may provide predictive value among pediatric patients undergoing congenital heart surgery. Objective To examine the role of a common polymorphism on postoperative tachyarrhythmias in a large cohort of pediatric patients undergoing congenital heart surgery with cardiopulmonary bypass (CPB). Methods Subjects undergoing congenital heart surgery with CPB at our institution were consecutively enrolled from September 2007 through December 2012. In addition to DNA, perioperative clinical data were obtained from subjects. Results Postoperative tachyarrhythmias were documented in 45% of 886 enrollees, and were associated with prolonged mechanical ventilation (p<0.001) and ICU length of stay (p<0.001). ACE I/D was in Hardy-Weinberg equilibrium (19% I/I, 49% I/D, 32% D/D). I/D or D/D genotypes were independently associated with a 60% increase in odds of new tachyarrhythmia (OR 1.6, 95%CI 1.1–2.3, p=0.02). Preoperative ACE inhibitor administration was independently associated with a 47% reduction in odds of postoperative tachyarrhythmia in the entire cohort (OR 0.53, 95%CI 0.32–0.88, p=0.01), driven by a five-fold reduction in tachyarrhythmias among I/I genotype patients (OR 0.19, 95% CI 0.04–0.88, p=0.02). Conclusions The risk of tachyarrhythmias after congenital heart surgery is independently affected by the ACE I/D polymorphism. Preoperative ACE inhibition is associated with a lower risk of postoperative tachyarrhythmias, an antiarrhythmic effect that appears genotype dependent. An understanding of genotype variation may play an important role in the perioperative management of congenital heart surgery.

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Section: Discussionmentioning

confidence: 99%

A common angiotensin-converting enzyme polymorphism and preoperative angiotensin-converting enzyme inhibition modify risk of tachyarrhythmias after congenital heart surgery

et al. 2014

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“…However, it has been shown that the angiotensin II type 1 (AT 1 ) receptor antagonist reduced heart rate and QT dispersion in hypertensive patients and the two actions were independent of changes in blood pressure (BP) (3). AT 1 antagonist losartan directly modified the human cardiac repolarizing K + currents (4), which means that the reduction in VAs may not be a consequence of depressurization and hypertrophic changes. The present study tested the hypothesis that the AT 1 receptor antagonist reversed repolarization abnormities of LV myocytes in spontaneously hypertensive (SH) rats which was independent of changes in BP.…”

Section: Introductionmentioning

confidence: 99%

Long-term treatment of spontaneously hypertensive rats with losartan and molecular basis of modulating Ito of ventricular myocytes

Zhang

Huang

et al. 2014

Molecular Medicine Reports

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The present study aimed to determine the effect of chronic treatment with losartan on transient outward potassium current (Ito) and the expression levels of potassium voltage-gated channel subfamily D members 2 and 3 (Kv4.2 and 3) and voltage-gated potassium channel-interacting protein 2 (KChIP2) in rats. Spontaneously hypertensive (SH) rats and Wistar-Kyoto (WKY) rats were used in the study. The rats were divided into lo-SH and SH groups and los-WKY and WKY groups, respectively. Ito was recorded and expression levels of Kv4.2, Kv4.3 and KChIP2 were measured by western blot analysis and quantitative polymerase chain reaction. Ito current density was smaller in SH compared with WKY, los-WKY and los-SH groups (P<0.01). Inactivation time constant of myocytes was larger in SH compared with WKY, los-WKY and los-SH groups (P<0.01). The mean levels of mRNA and protein of Kv4.2 and Kv4.3 were significantly lower in the SH compared with WKY, los-WKY and los‑SH groups in vivo and in vitro (P<0.01). The Pearson statistical test showed no correlation between the expression levels of Kv4.2, Kv4.3, KChIP2 and the changes in blood pressure in the losartan treatment group. In conclusion, chronic blockade of angiotensin II type 1 receptors with losartan reversed SH rats' electrical remodeling and shortened action potential duration, which was associated with an increase in Ito density as the expression levels of Kv4.2, Kv4.3 increased and the expression levels of KChIP2 decreased. However, the expression levels of Kv4.2, Kv4.3 and KChIP2 were not correlated with the change in blood pressure in the losartan treatment group. Losartan may decrease the inactivation time by increasing the expression of KChIP2.

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“…Atrial fibrillation (AF) occurs in 20-50% of patients following cardiac surgery [28][29][30][31] , with incidence peaking on the second postoperative day 32 . Postoperative AF leads to prolonged hospital length of stay 33 , higher hospital costs [33][34][35][36] and increased in-hospital and 4-year mortality 37,38 .…”

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confidence: 99%

Perioperative Management of Patients Treated with Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers: A Quality Improvement Audit

Vijay

Grover

et al. 2016

Anaesth Intensive Care

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Previous studies have shown that patients continuing angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers on the day of surgery are more likely to have significant intraoperative hypotension, higher rates of postoperative acute kidney injury, and lower incidences of postoperative atrial fibrillation. However, many of these studies were prone to bias and confounding, and questions remain over the validity of these outcomes. This observational, before-and-after quality improvement audit aimed to assess the effect of withholding these medications on the morning of surgery. We recruited 323 participants, with 83 (26%) having their preoperative angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) withheld on the day of surgery. There were only very small Spearman rank-order correlations between time since last dose of these medications (rho -0.12, P=0.057) and intraoperative and recovery room intravenous fluid administration (rho -0.11, P=0.042). There was no statistically significant difference between the continued or withheld groups in vasopressor (metaraminol use 3.5 [1.5-8.3] mg versus 3.5 [1.5-8.5] mg, P=0.67) or intravenous fluid administration (1000 ml [800-1500] ml versus 1000 [800-1500] ml, P=0.096), nor rates of postoperative acute kidney injury (13% vs 18%, P=0.25) or atrial fibrillation (15% versus 18%, P=0.71). This audit found no significant differences in measured outcomes between the continued or withheld ACEi/ARB groups. This finding should be interpreted with caution due to the possibility of confounding and an insufficient sample size. However, as the finding is in contrast to many previous studies, future prospective randomised clinical trials are required to answer this important question.

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Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Risk of Atrial Fibrillation before Coronary Artery Bypass Grafting

Cited by 7 publications

References 11 publications

A common angiotensin-converting enzyme polymorphism and preoperative angiotensin-converting enzyme inhibition modify risk of tachyarrhythmias after congenital heart surgery

A common angiotensin-converting enzyme polymorphism and preoperative angiotensin-converting enzyme inhibition modify risk of tachyarrhythmias after congenital heart surgery

Long-term treatment of spontaneously hypertensive rats with losartan and molecular basis of modulating Ito of ventricular myocytes

Perioperative Management of Patients Treated with Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers: A Quality Improvement Audit

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