Angiotensin Receptor Blocker and Calcium Channel Blocker Preventing Atrial Fibrillation Recurrence in Patients with Hypertension and Atrial Fibrillation: A Meta-analysis

Ma, Haotian; Jiang, Hongcheng; Feng, Jing; Gan, Yong

doi:10.1155/2021/6628469

Cited by 10 publications

(8 citation statements)

References 32 publications

(77 reference statements)

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“…Experimental models have demonstrated that suppressing this pathway leads to a reduction in interstitial fibrosis by inhibiting both the mineralocorticoid receptor and the AT1-R [ 43 , 44 ]. This correlates with clinical trials, that have shown the efficacy of the inhibition of this axis for primary prevention of AF, especially in hypertension and heart failure populations, and in preventing AF recurrence after cardioversion and in patients with paroxysmal AF under medical therapy [ 45 , 46 , 47 , 48 ], which suggest a potential role for these therapeutic targets in AF secondary prevention. Nonetheless, this has not shown a reduction in mortality [ 49 ].…”

Section: The Hallmarks Of Atrial Fibrillationsupporting

confidence: 79%

Tic-Tac: A Translational Approach in Mechanisms Associated with Irregular Heartbeat and Sinus Rhythm Restoration in Atrial Fibrillation Patients

Parra-Lucares,

Villa,

Romero-Hernández

et al. 2023

IJMS

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Atrial fibrillation (AF) is a prevalent cardiac condition predominantly affecting older adults, characterized by irregular heartbeat rhythm. The condition often leads to significant disability and increased mortality rates. Traditionally, two therapeutic strategies have been employed for its treatment: heart rate control and rhythm control. Recent clinical studies have emphasized the critical role of early restoration of sinus rhythm in improving patient outcomes. The persistence of the irregular rhythm allows for the progression and structural remodeling of the atria, eventually leading to irreversible stages, as observed clinically when AF becomes permanent. Cardioversion to sinus rhythm alters this progression pattern through mechanisms that are still being studied. In this review, we provide an in-depth analysis of the pathophysiological mechanisms responsible for maintaining AF and how they are modified during sinus rhythm restoration using existing therapeutic strategies at different stages of clinical investigation. Moreover, we explore potential future therapeutic approaches, including the promising prospect of gene therapy.

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Section: The Hallmarks Of Atrial Fibrillationsupporting

confidence: 79%

Tic-Tac: A Translational Approach in Mechanisms Associated with Irregular Heartbeat and Sinus Rhythm Restoration in Atrial Fibrillation Patients

Parra-Lucares,

Villa,

Romero-Hernández

et al. 2023

IJMS

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“…Atrial electrical remodeling induced by Ang II associates with several ion channel alterations, presenting with the increase in APD in both the right and left atria. In Ang IItreated mice, INaP reduction in the left atria can lead to slow conduction; meanwhile, transient outward K + current (Ito) and the ultra rapid delayed rectifier K + current (Ikur) reduction in both atria could be involved in the delayed repolarization (23)(24)(25). These ion channel alterations could lead to EADs, as well as trigger the occurrence and maintain the persistence of AF.…”

Section: Discussionmentioning

confidence: 99%

Moricizine prevents atrial fibrillation by late sodium current inhibition in atrial myocytes

Tian¹,

Chen²,

Chen³

et al. 2022

J Thorac Dis

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Background: Enhanced late sodium current (INaL) is reportedly related to an increased risk of atrial fibrillation (AF). Moricizine, as a widely used anti-arrhythmia drug for suppressing ventricular tachycardia, has also been shown to prevent paroxysmal AF. However, the mechanism of its therapeutic effect remains poorly understood.Methods: Angiotensin II (Ang II) was induced in C57Bl/6 mice (male wild-type) for 4 weeks to increase the susceptibility of AF, and acetylcholine-calcium chloride was used to induce AF. The whole-cell patch-clamp technique was used to detect INaL from isolated atrial myocytes. The expression of proteins in atrial of mice and HL-1 cells were examined by Western-blot. Results:The results showed that moricizine significantly inhibited Ang II-mediated atrial enlargement and reduced AF vulnerability. We found that the densities of INaL were enhanced in Ang II-treated left and right atrial cardiomyocytes. Simultaneously, the Ang II-induced increase in INaL currents density was alleviated by the administration of moricizine, and no alteration in Nav1.5 expression was observed. In normal isolated atrial myocytes, moricizine significantly reduced Sea anemone toxin II (ATX II)-enhanced INaL density with a reduction of peak sodium currents. In addition, moricizine reduced the Ang II-induced upregulation of phosphorylated calcium/calmodulin-dependent protein kinase-II (p-CaMKII) in both the left and right atria.In HL-1 cells, moricizine also reduced the upregulation of p-CaMKII with Ang II and ATX II intervention, respectively. Conclusions: Our results indicate that Ang II enhances the INaL via activation of CaMKII. Moricizine inhibits INaL and reduces CaMKII activation, which may be one of the mechanisms of moricizine suppression of AF.

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Section: Early Transition To Management Of Atrial Fibrillation In Hyp...mentioning

confidence: 99%

“…52 Those results were confirmed in another meta-analysis (7 randomized clinical trials; 1495 patients), in which renin-angiotensin inhibitor therapy had a significant superiority in preventing AF recurrence (OR, 0.43 [95% CI, 0.30-0.72]) and persistent AF (OR, 0.41 [95% CI, 0.24-0.71]) compared with calcium channel blocker treatment. 53 BP targets. In the Substrate Modification With Aggressive Blood Pressure Control (SMAC-AF) trial 54 with 184 participants, isolated antihypertensive treatment (targeting BP <120/80 mm Hg) did not reduce atrial arrhythmia (AF/atrial flutter/tachycardia) recurrence after catheter ablation.…”

Section: Hypertension Treatment For Secondary Prevention Of Prevalent...mentioning

confidence: 99%

Atrial Fibrillation Detection and Management in Hypertension

Gawałko

Linz

2023

Hypertension

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Hypertension is prevalent in >70% of atrial fibrillation patients. In turn, hypertensive patients have up to 73% greater likelihood of atrial fibrillation. Current guidelines recommend that a systematic atrial fibrillation screening may be justified in all patients aged ≥65 years with at least 1 cardiovascular disease, including hypertension. Although most blood pressure monitors include algorithms to detect atrial fibrillation with a high sensitivity of 96 [92–98]% and specificity of 94 [91–96]%, an electrocardiography confirmation is necessary to establish a diagnosis of atrial fibrillation. Early detection and diagnosis of atrial fibrillation is important to allow initiation of atrial fibrillation management. In the EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial), hypertension was present in 88% of participants, and early rhythm control therapy lowered the risk of adverse cardiovascular outcomes in patients with early atrial fibrillation aged >75 or with CHA 2 DS 2 -VASc score ≥2 and cardiovascular condition. Strategies for early atrial fibrillation detection should always be linked to a comprehensive atrial fibrillation work-up infrastructure organized within an integrated ABC pathway (“A” Anticoagulation/Avoid stroke; “B” Better symptom control; “C” Cardiovascular and Comorbidity optimization). For secondary prophylaxis, blood pressure control should be embedded in a combined risk factor management program. In hypertensive patients where no atrial fibrillation is detected, intensive blood pressure lowering therapy for primary prophylaxis should be initiated to reduce the risk of developing atrial fibrillation and other cardiovascular complications in the future. The aim of the article is to review the current literature on atrial fibrillation detection and management in hypertensive patients.

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Angiotensin Receptor Blocker and Calcium Channel Blocker Preventing Atrial Fibrillation Recurrence in Patients with Hypertension and Atrial Fibrillation: A Meta-analysis

Cited by 10 publications

References 32 publications

Tic-Tac: A Translational Approach in Mechanisms Associated with Irregular Heartbeat and Sinus Rhythm Restoration in Atrial Fibrillation Patients

Tic-Tac: A Translational Approach in Mechanisms Associated with Irregular Heartbeat and Sinus Rhythm Restoration in Atrial Fibrillation Patients

Moricizine prevents atrial fibrillation by late sodium current inhibition in atrial myocytes

Atrial Fibrillation Detection and Management in Hypertension

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