Beta-blockers prevent subacute recurrences of persistent atrial fibrillation only in patients with hypertension*1

Abstract

Compared with lone AF patients, patients in the setting of hypertension maintain sinus rhythm much better after cardioversion when treated with a beta-blocker. Beta-blockade protects, in particular, against the early subacute recurrences. These findings underscore the importance of a differential approach towards drug prevention of post-cardioversion recurrences depending on the underlying heart disease.

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

“…Compared with patients with lone AF, those with hypertension are more likely to maintain sinus rhythm after cardioversion of persistent AF when treated with a beta blocker. 764 Drugs modulating the renin-angiotensin system reduce structural cardiac changes, 765 and ACE inhibition was associated with a lower incidence of AF compared with calcium channel blockade in patients with hypertension during 4.5 y of follow-up in a retrospective, longitudinal cohort study from a database of 8 million patients in a managed care setting. 42 In patients at increased risk of cardiovascular events, therapy with either the ACE inhibitor ramipril 766 -768 or angiotensin receptor antagonist losartan 769,770 lowered the risk of stroke.…”

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary

“…Compared to patients with lone AF, those with hypertension are more likely to maintain sinus rhythm after cardioversion of persistent AF when treated with a beta blocker. 318 Drugs modulating the RAAS reduce structural cardiac changes, 319 and ACE inhibition was associated with a lower incidence of AF compared with calcium channel blockade in patients with hypertension during 4.5 y of follow-up in a retrospective, longitudinal cohort study from a database of 8 million patients in a managed care setting. 320 In patients at increased risk of cardiovascular events, therapy with either the ACE inhibitor ramipril [321][322][323] or angiotensin receptor antagonist, losartan 324,325 lowered the risk of stroke.…”

Comparison of Angiotensin Converting Enzyme Inhibitors and Beta Blockers in Prevention of Atrial Fibrillation Recurrences After Electrical Cardioversion Elektriksel Kardiyoversiyon Sonrasında Atriyal

“…In fact, others demonstrated that preventive effect of metoprolol from AF recurrence still persevered despite initiation on the day of cardioversion (12). However, none of the studies above (12,18) used the combination of amiodarone and beta blocker together. So, amiodarone might have masked the effects of metoprolol on AF recurrences, in the present study.…”

“…In our study, the spectrum of underlying heart diseases were similar among groups. Van Noord et al also underscored the importance of initiating beta blocker therapy before the scheduled cardioversion, especially in terms of preventing earlier relapses (18). This was further pronounced by the study of Workman et al, in which atrial electrophysiological changes such as prolongation of atrial action potential duration and effective refractory period were suggested to be consistent with a long-term adaptive response, a type of "pharmacological remodeling", that appears as a result of long-term beta blockade (19).…”

“…Van Noord et al demonstrated that the beneficial effects of beta blockers in preventing AF relapse after cardioversion were Months to recurrence 5±3 5.8±3.6 6.3±3.4 Heart rate at the end of follow-up,bpm* 68±11 63±7 70±9 Withdrawn because of adverse effect at the end of follow up, n 4 8 5 Table 2: End-points more pronounced in the setting of hypertension rather than lone AF (18). The possible mechanism was suggested to be the lengthening of diastole, thereby decreasing atrial stretch related arrhythmogenicity.…”