Renin-angiotensin system inhibitors for prevention of recurrent atrial fibrillation: a meta-analysis

Li, T.-J.; Zang, Weidong; Chen, Y.-L.; Geng, Ning; Ma, Siddiqui; Li, X.-D.

doi:10.1111/ijcp.12063

Cited by 13 publications

(14 citation statements)

References 30 publications

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“…Although the details remain unclear, the persistence of AF is considered as a result of atrial remodeling, which could in turn contribute to the initiation and development of AF [ 14 ]. LAD enlargement triggers the activation of the renin aldosterone angiotensin system (RAAS) and subsequently lead to increase in matrix metalloproteinases, which result in atrial remodeling and fibrosis, with loss of atrial muscle mass [ 32 ]. In addition, interstitial fibrosis may induce local intra-atrial conduction block and increase atrial susceptibility to AF, as well as forming stable local sources for AF induction [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Associations of MMP-2, BAX, and Bcl-2 mRNA and Protein Expressions with Development of Atrial Fibrillation

Diao

Zhang

et al. 2016

Med Sci Monit

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BackgroundTo examine changes of mRNA and protein expressions of MMP-2, Bcl-2, and BAX in atrial fibrillation (AF) patients, and investigate the correlations among these 3 biomarkers.Material/MethodsRheumatic heart disease patients (n=158) undergoing cardiac surgical procedures for mitral valve repair or replacement were included as the AF group (n=123), containing paroxysmal AF (n=42), persistent AF (n=36), and permanent AF (n=45). Rheumatic heart disease patients with sinus rhythm (SR) (n=35) were enrolled as the SR group (control group). Immunohistochemistry, Western blot, and real-time polymerase chain reaction (PCR) were applied to detect the protein and mRNA expression levels of MMP-2, Bcl-2, and BAX. Apoptosis was observed with light and electron microscopes and detected by TdT-mediated dUTP nick-end labeling (TUNEL).ResultsCompared with the SR group, the left atrial diameters (LADs), protein and mRNA expression levels of MMP-2 and BAX, apoptotic index (AI), and Bcl-2/BAX ratio were evidently increased in the 3 AF groups, but protein and mRNA expression levels of Bcl-2 decreased in the AF groups (all P<0.05). Correlation analysis found that MMP-2 protein expression levels was positively correlated with BAX expression, but negatively correlated with Bcl-2 expression levels.ConclusionsOur study results suggest that elevated MMP-2 expression and disturbance balance of Bcl-2/BAX expressions may be associated with the development and maintenance of AF. MMP-2 may be involved in the development of AF through promoting BAX expressions and inhibiting Bcl-2.

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Section: Discussionmentioning

confidence: 99%

Associations of MMP-2, BAX, and Bcl-2 mRNA and Protein Expressions with Development of Atrial Fibrillation

Diao

Zhang

et al. 2016

Med Sci Monit

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“…The effects of treatment with angiotensin‐converting enzyme inhibitors (ACE‐Is) or angiotensin receptor blockers (ARBs), in the primary or secondary prevention of AF, showed a significant reduction in the risk for AF recurrence after cardioversion with the use of ACE‐Is or ARBs, reducing the odds for secondary AF by 33% . A recent meta‐analysis of 3972 patients with AF showed that inhibition of RAS is effective, safe, and well tolerated for preventing the recurrence of AF …”

Section: Predictors Of Maintenance Of Sinus Rhythm After Successful Cmentioning

confidence: 99%

“…8 A recent meta-analysis of 3972 patients with AF showed that inhibition of RAS is effective, safe, and well tolerated for preventing the recurrence of AF. 9 The left atrial (LA) diameter is a powerful predictor of AF recurrence as shown in more than one AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) analysis. 10,11 AF recurrence is more likely to occur within 6 months after a successful cardioversion if left atrial enlargement is present, especially when the (LA) diameter exceeds 5.0 cm.…”

Section: Predictors Of Maintenance Of Sinus Rhythm After Successful Cmentioning

confidence: 99%

Predictors of Long‐term Maintenance of Normal Sinus Rhythm After Successful Electrical Cardioversion

Abu-El-Haija

Giudici

2014

Clinical Cardiology

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Electrical cardioversion (EC) for atrial fibrillation (AF) is a common procedure performed in an attempt to restore normal sinus rhythm (NSR). Many factors predict long-term maintenance of NSR and the risk of AF recurrence. The duration of AF, cardiac size and function, rheumatic heart disease, significant mitral valve disease, left atrial enlargement, and older age are among the most common recognized factors. A number of interventions can potentially decrease the AF recurrence rate. Identifying and treating reversible causes and the use of antiarrhythmic medications in certain situations can help decrease the risk of AF recurrence. The role of the newer anticoagulants is expanding, and wider application is expected in the near future. We hope that this summary will serve as a guide to physicians and healthcare providers to address the question of who should undergo cardioversion, as there are patients who are most likely to benefit from this procedure and others that will revert back into AF within a short period. To identify who would benefit most from EC and have a reasonable chance of long-term maintenance of NSR, a thorough evaluation of each individual patient should be performed to tailor the best therapy to each individual.

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“…Angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers are commonly used in all grades of HF and in hypertension. They increase the likelihood of long‐term SR after ECV . However, more research is required, as some studies show no benefit to RAS blockade and they are not recommended for routine use pre‐ECV.…”

Section: Af and Patient Factorsmentioning

confidence: 99%

A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation

Ecker

Knoery

Rushworth

et al. 2018

Clinical Cardiology

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Atrial fibrillation is the most common heart-rhythm disorder, affecting about 1.5% to 2% of the population with an increased risk of mortality and morbidity due to stroke, thromboembolism, and heart failure. If the conversion back to sinus rhythm does not happen spontaneously, pharmacological or electrical cardioversion (ECV) is the next available treatment options for some patients. However, the long-term success following ECV is variable. This review describes the factors that are associated with maintenance of sinus rhythm following ECV and proposes a clinical strategy based on the available evidence.Atrial fibrillation (AF) is a supraventricular arrhythmia characterized by extremely rapid and uncoordinated electrical activity in the atria with variable conduction through the atrioventricular node, resulting in irregular, and often rapid, ventricular contraction. AF is the most common sustained heart-rhythm disorder in the developed world, found in 1% to 2% of the general population, with a higher prevalence in females and older patients.1 Because of an aging population, it is likely that AF patient numbers will continue to rise, along with associated increases in healthcare costs. 2 Palpitations, breathlessness, fatigue, and reduced exercise tolerance are AF-associated symptoms, and there is an increased risk of stroke with AF, with the need for anticoagulation. 2In some patients, AF will be permanent and therapy is aimed at controlling the ventricular rate (rate-control strategy). In other patients, normal rhythm initially can be restored with pharmacological or electrical cardioversion (ECV) but often requires additional strategies to maintain sinus rhythm (SR; rhythm-control strategy).There is no convincing mortality benefit to achieving rhythm control over rate control; therefore, treatment decisions are usually based on the presence of symptoms and the perceived likelihood of successful cardioversion. Cardioversion can be achieved by pharmacological methods or ECV; however, maintenance of SR may only be temporary. [3][4][5][6][7] The use of ECV may be indicated where pharmacological rhythm-control strategies have failed and the patient remains symptomatic. Patient selection is important, as the maintenance of longterm SR can be difficult. The advantages of ECV are that it is associated with a high initial success rate (68%-98%) 8 ; however, it requires sedation or general anesthesia, and although initially successful, longterm maintenance of SR is not reliably achieved. 9 AF relapse following ECV is also associated with increased mortality, 10 thus highlighting the importance of identifying the correct patient group for cardioversion and, where possible, addressing reversible factors associated with poorer outcomes. Furthermore, it is crucial at the time of ECV that patients are appropriately prepared with adequate hydration and correction of any electrolyte abnormalities. ECV should also be avoided in stable patients with concurrent infection or significant inflammation.Many factors have been reported ...

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Renin-angiotensin system inhibitors for prevention of recurrent atrial fibrillation: a meta-analysis

Abstract: Based on the currently available data, inhibition of RAS is effective, safe and well tolerated for preventing the recurrence of AF.

Cited by 13 publications

References 30 publications

Associations of MMP-2, BAX, and Bcl-2 mRNA and Protein Expressions with Development of Atrial Fibrillation

Associations of MMP-2, BAX, and Bcl-2 mRNA and Protein Expressions with Development of Atrial Fibrillation

Predictors of Long‐term Maintenance of Normal Sinus Rhythm After Successful Electrical Cardioversion

A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation

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