Renin–angiotensin system inhibitors can suppress atrial fibrillation recurrence after encircling ipsilateral pulmonary vein isolation in patients with a non-dilated left atrium

Abstract

Introduction: The purpose of this study was to investigate whether the effects of renin-angiotensin system inhibitors (RASIs) after encircling ipsilateral pulmonary veins isolation (EIPVsI) for atrial fibrillation (AF) differed between patients with non-dilated and dilated left atria. Materials and methods: We retrospectively studied 292 consecutive patients (mean age=61±11 years, 75% males) who underwent successful EIPVsI for paroxysmal or persistent AF. RASIs' effects were compared between the patients with a non-dilated left atrium of <40 mm (n=178) and dilated left atrium of ≥40 mm (n=114). Results: During a mean follow-up period of 18.9±12.7 months, AF recurred in 38 (21.4%) and 45 (39.5%) patients with non-dilated and dilated left atria, respectively. A multivariate Cox proportional analysis revealed that treatment with RASIs (hazard ratio (HR) 0.30, 95% confidence interval (CI) =0.13-0.66, p=0.003), the duration of AF (HR 1.08/year, 95% CI=1.01-1.16, p=0.03), a history of hypertension (HR 2.86, 95% CI=1.21-6.85, p=0.02) and the left ventricular ejection fraction (HR 0.54/10%↑, 95% CI=0.34-0.87, p=0.01) were associated with AF recurrences in patients with a non-dilated left atrium. On the other hand, only the duration of AF (HR 1.11/year, 95% CI=1.01-1.21, p=0.03) was associated with AF recurrences in those with a dilated LA, and RASIs had no effect on AF recurrences (p=0.65). Conclusions: RASIs suppressed AF recurrences after EIPVsI only in patients with a non-dilated left atrium.

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.…”

A Systematic Review and Meta-analysis of Renin–angiotensin System Inhibitors and Angiotensin Receptor Neprilysin Inhibitors in Preventing Recurrence After Atrial Fibrillation Ablation

“…Nineteen studies 7,14–31 reported the effect of RASIs on AF recurrence after ablation. The results showed that the recurrence rate of AF in subjects who received RASIs was lower than that of subjects who did not receive RASIs [RR = 0.85, 95% CI (0.72–0.99), P = 0.03] (Fig.…”

“…A total of 2739 articles were obtained after the initial screening. After eliminating duplicate articles, 22 articles 7,11–31 were finally included according to the inclusion and exclusion criteria. The literature screening process and results are shown in the Supplemental Digital Content 1 ( PRISMA flow chart , http://links.lww.com/JCVP/B10).…”

“…The Effect of RASIs on AF Recurrence Nineteen studies 7,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] reported the effect of RASIs on AF recurrence after ablation. The results showed that the…”