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

Zhao, Jianqiang; Chen, Miao; Zhuo, Chengui; Huang, Yuan; Zheng, Liangrong; Wang, Qiqi

doi:10.1536/ihj.20-346

Cited by 5 publications

(7 citation statements)

References 49 publications

(51 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The reason for this may be that low LVEF leads to the elevation of left atrial pressure 18 and the prolonged elevation of left atrial pressure can lead to myocardial damage and atrial fibrosis. 19 , 20 Atrial fibrosis can cause conduction disturbances and make contribution to the progression of atrial remodeling, which result in AF. 21 , 22 Previous research showed that the SIS was associated with higher risk of AF occurrence.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Risk Nomogram Model for Predicting Recurrence in Patients with Atrial Fibrillation After Radiofrequency Catheter Ablation

Zhao¹,

Zhang²,

Ma³

et al. 2022

CIA

View full text Add to dashboard Cite

Purpose This study aimed to develop and validate a risk nomogram model for predicting the risk of atrial fibrillation recurrence after radiofrequency catheter ablation. Patients and Methods A retrospective observational study was conducted using data from 485 patients with atrial fibrillation who underwent the first radiofrequency ablation in our hospital from January 2018 to June 2021. All patients were randomized into training cohort (70%; n=340) and validation cohort (30%; n=145). Univariate and multivariate logistic regression analyses were used to identify independent risk factors. The predictive nomogram model was established by using R software. The nomogram was developed and evaluated based on differentiation, calibration, and clinical efficacy by concordance statistic (C-statistic), calibration plots, and decision curve analysis (DCA), respectively. Results The nomogram was established by four variables including left atrial diameter (OR 1.057, 95% CI 1.010–1.107, P =0.018), left ventricular ejection fraction (OR 0.943, 95% CI 0.905–0.982, P =0.005), type of atrial fibrillation (OR 2.164, 95% CI: 1.262–3.714), and systemic inflammation score (OR 1.905, 95% CI 1.408–2.577). The C-statistic of the nomogram was 0.741 (95% CI: 0.689–0.794) in the training cohort and 0.750 (95% CI: 0.670–0.831) in the validation cohort. The calibration plots showed good agreement between the predictions and observations in the training and validation cohorts. Decision curve analysis and clinical impact curves indicated the clinical utility of the predictive nomogram. Conclusion The nomogram model has good discrimination and accuracy, which can screen high-risk groups intuitively and individually, and has a certain predictive value for atrial fibrillation recurrence in patients after radiofrequency ablation.

show abstract

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Risk Nomogram Model for Predicting Recurrence in Patients with Atrial Fibrillation After Radiofrequency Catheter Ablation

Zhao¹,

Zhang²,

Ma³

et al. 2022

CIA

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Renin‐angiotensin system (RAS) inhibitors significantly reduce the recurrence of atrial fibrillation in patients following catheter ablation (OR, 0.61; 95% CI, 0.45–0.82). 5 The arrhythmogenic substrate of AF is driven by atrial fibrosis, 6 and AF itself also promotes atrial fibrosis. 7 ALD binding to the mineralocorticoid receptor and subsequent cardiac fibrosis formation is strongly associated with increased AF propensity.…”

Section: Discussionmentioning

confidence: 99%

“…One meta‐analysis by Zhao suggested that RAS inhibitors were of significant benefit in reducing the recurrence rate of AF after catheter ablation. 5 Rienstra et al showed that MRA therapy improves sinus rhythm maintenance in patients with persistent AF and mild‐to‐moderate heart failure. 13 The AngII and ALD serum levels were significantly lower in Group PVI/SP 3 months after surgery than before surgery (both p < .001).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Radiofrequency catheter ablation combined with spironolactone in the treatment of atrial fibrillation: A single‐center randomized controlled study

Wang

Chen

Zhang

et al. 2021

Clinical Cardiology

View full text Add to dashboard Cite

At present, the question of whether radiofrequency ablation (RFA) combined with spironolactone can reduce the levels of plasma angiotensin II (AngII) and aldosterone (ALD) in patients with atrial fibrillation (AF) and reduce the recurrence of AF has not been reported. Hypothesis The present study evaluates the effect of spironolactone as an ALD antagonist on the short‐term and long‐term recurrence of AF after RFA. A total of 203 patients were enrolled in the present study, with 102 patients in the spironolactone therapy group (Group PVI/SP) and 101 patients in the control group (Group PVI alone). The AngII and ALD levels and the size of the left atrium in patients with AF were observed in order to evaluate the relationship between the combination therapy of spironolactone with RFA and the success rate in AF treatment. After therapy, the levels of AngII (52.8 vs. 64.3 pg/ml, p < .001), ALD (45.7 vs. 60.6 pg/ml, p = .016), and N‐terminal of B‐type natriuretic peptide (NT‐proBNP) (73.5 vs. 110 pg/ml, p = .016), along with the size of the left atrium (35.8 vs. 37.2 mm, p = .007), were all significantly lower in Group PVI/SP compared with Group PVI alone. The cumulative AF‐free survival rate was higher in Group PVI/SP than in Group PVI alone after treatment (85.3% vs.73.3%, p = .033). In RFA combined with spironolactone treatment, spironolactone can directly antagonize the effects of ALD and AngII and the recurrence of AF and improve left ventricular function.

show abstract

“…These pathological mechanisms are based on the abnormality of ion channels (41). A meta-analysis suggested that renin-angiotensin system inhibitors may contribute to a reduction in the recurrence rate of atrial fibrillation after catheter ablation (48). Interestingly, the estrogen (E2) signaling pathway was shared by GLT and HET, while the GnRH signaling pathway was only linked with GLT, although both the pathways belong to the same endocrine system category.…”

Section: Shared Signaling Pathways Of Pharmacogeneticsmentioning

confidence: 99%

Integrated Pharmacogenetics Analysis of the Three Fangjis Decoctions for Treating Arrhythmias Based on Molecular Network Patterns

Wei

Long

Tan

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Aim: To explore the diverse target distribution and variable mechanisms of different fangjis prescriptions when treating arrhythmias based on the systems pharmacology.Methods: The active ingredients and their corresponding targets were acquired from the three fangjis [Zhigancao Tang (ZT), Guizhigancao Longgumuli Tang (GLT), and Huanglian E'jiao Tang (HET)] and the arrhythmia-related genes were identified based on comprehensive database screening. Networks were constructed between the fangjis and arrhythmia and used to define arrhythmia modules. Common and differential gene targets were identified within the arrhythmia network modules and the cover rate (CR) matrix was applied to compare the contributions of the fangjis to the network and modules. Comparative pharmacogenetics analyses were then conducted to define the arrhythmia-related signaling pathways regulated by the fangjis prescriptions. Finally, the divergence and convergence points of the arrhythmia pathways were deciphered based on databases and the published literature.Results: A total of 187, 105, and 68 active ingredients and 1,139, 1,195, and 811 corresponding gene targets of the three fangjis were obtained and 102 arrhythmia-related genes were acquired. An arrhythmia network was constructed and subdivided into 4 modules. For the target distribution analysis, 65.4% of genes were regulated by the three fangjis within the arrhythmia network. ZT and GLT were more similar to each other, mainly regulated by module two, whereas HET was divided among all the modules. From the perspective of signal transduction, calcium-related pathways [calcium, cyclic guanosine 3′,5′-monophosphate (cGMP)-PKG, and cyclic adenosine 3′,5′-monophosphate (cAMP)] and endocrine system-related pathways (oxytocin signaling pathway and renin secretion pathways) were associated with all the three fangjis prescriptions. Nevertheless, heterogeneity existed between the biological processes and pathway distribution among the three prescriptions. GLT and HET were particularly inclined toward the conditions involving abnormal hormone secretion, whereas ZT tended toward renin-angiotensin-aldosterone system (RAAS) disorders. However, calcium signaling-related pathways prominently feature in the pharmacological activities of the decoctions. Experimental validation indicated that ZT, GLT, and HET significantly shortened the duration of ventricular arrhythmia (VA) and downregulated the expression of CALM2 and interleukin-6 (IL-6) messenger RNAs (mRNAs); GLT and HET downregulated the expression of CALM1 and NOS3 mRNAs; HET downregulated the expression of CRP mRNA.Conclusion: Comparing the various distributions of the three fangjis, pathways provide evidence with respect to precise applications toward individualized arrhythmia treatments.

show abstract

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

Cited by 5 publications

References 49 publications

Development and Validation of a Risk Nomogram Model for Predicting Recurrence in Patients with Atrial Fibrillation After Radiofrequency Catheter Ablation

Development and Validation of a Risk Nomogram Model for Predicting Recurrence in Patients with Atrial Fibrillation After Radiofrequency Catheter Ablation

Radiofrequency catheter ablation combined with spironolactone in the treatment of atrial fibrillation: A single‐center randomized controlled study

Integrated Pharmacogenetics Analysis of the Three Fangjis Decoctions for Treating Arrhythmias Based on Molecular Network Patterns

Contact Info

Product

Resources

About