Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on the Long-Term Outcome after Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

Abstract

Objectives: The effect of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARBs) on the long-term outcome after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) is unknown. Methods: This matched-pair study included 102 patients with PAF treated with ACE-I or ARBs (group 1) and 102 control subjects (group 2) after standardized PVI. Tele-ECG recorders were used to detect the end point of the first PAF recurrence after a 3-month blanking period. Results: Median follow-up was 2.1 years (range 0.3–6.3). In group 1, 51 (50%) patients suffered recurrences, with a mean time to recurrence of 3.2 years (95% CI 2.6–3.8). In group 2, 67 (65.7%) patients presented PAF after a mean period of 2.2 years (95% CI 1.7–2.8; p = 0.009). A second ablation was performed in 31 (50%) patients from the treatment group and in 48 (66.7%) patients from the control group (p = 0.02). Multivariate Cox analysis showed treatment with ACE-I and ARBs to be the only significant predictor of a reduced recurrence rate (HR 0.49, 95% CI 0.32–0.75). Conclusion: ACE-I and ARBs were effective for the preservation of sinus rhythm after PAF ablation, and they reduced the reablation rate.

Association of angiotensin-converting enzyme gene I/D and CYP11B2 gene −344T/C polymorphisms with lone atrial fibrillation and its recurrence after catheter ablation

“…The renin-angiotensin-aldosterone system (RAAS) blockers, not only reduce the risk of lone AF in normotensive and hypertensive patients, but also prevent AF recurrence (6–8). RAAS has been shown in several studies to promote inflammation, oxidation and fibrosis (9,10).…”

Renin-Angiotensin System Inhibitors for the Prevention of Atrial Fibrillation Recurrence After Ablation ― A Meta-Analysis ―

“…However, previous studies have yielded contradictory results. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Therefore, an unbiased meta-analysis is needed to establish the clinical role of RASIs. In this study we summarized the currently available evidence about the effect of RASI therapy for the prevention of AF recurrence after ablation, and we discuss the commonalities and differences among these trials.…”

The Effect of Renin-Angiotensin System Inhibitors on the Recurrence of Atrial Fibrillation After Catheter Ablation

“…Thus, 13 studies were eligible for inclusion in the analysis, of which 4 were RCTs [17][18][19][20] and the others were cohort studies. 21,22,[27][28][29][30][31][32][33] Of the 13 enrolled studies, the follow-up duration to detect AF recurrence after the catheter ablation ranged from 3 to 48 months. Out of a total of 3661 patients with AF, 1761 were allocated to the RAS inhibitor treatment group and 1900 to the control group.…”