Effect of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Patients Following Ablation of Atrial Fibrillation

Abstract

Background and ObjectivesIt is known that angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor blockers (ACEIs and ARBs, respectively) are effective in preventing atrial fibrillation (AF) in high-risk patients. However, it is not known whether ACEIs and ARBs are effective in preventing the recurrence of AF after catheter ablation.Subjects and MethodsOne hundred fifty-two patients (mean age, 57±10 years; M : F=94 : 58) who underwent catheter ablation due to drug-refractory paroxysmal (mean age, 57±10 years; M : F=58 : 43) or persistent AF (mean age, 56±10 years; M : F=36 : 15) were enrolled. We compared the recurrence rates between the groups with and without ACEIs or ARBs use in paroxysmal and persistent AF. The mean duration of follow-up was 18±14 months.ResultsThe overall recurrence rate after ablation therapy was 26% (n=39). The recurrence rate was significantly decreased in the patients with persistent AF with the use of ACEIs or ARBs (12.1% vs. 61.1%, p<0.01), but this difference was not observed in the patients with paroxysmal AF (24.2% vs. 22.9%, p=0.87). In patients with persistent AF with and without recurrence, the size of the left atrium (44.2±8.4 mm vs. 44.3±5.8 mm, respectively, p=0.45) and the ejection fraction (62±6.5% vs. 61.5±6.2%, respectively, p=0.28) were not significantly different. In multivariate analysis, the use of ACEIs or ARBs was independently associated with recurrence after adjusting for the size of the left atrium and the ejection fraction {odds ratio (OR)=0.078, 95% confidence interval (CI)=0.02-0.35, p<0.01}.ConclusionACEIs and ARBs were shown to be effective in preventing AF recurrence after catheter ablation in patients with persistent AF.

The effect of statins on the recurrence rate of atrial fibrillation after catheter ablation: A meta‐analysis

“…Consequently, 37 articles were excluded, of which 28 did not fulfill the inclusion criteria, five were editorials and comments, two were duplicates, and two did not include the necessary data required for the analysis. Ultimately, nine studies containing 1,607 patients were included in the meta‐analysis . From these nine studies, five were retrospective cohort studies and the remaining four studies were RCTs.…”

“…We identified these subgroups as Zhao and Zhao (1) to represent the different statin dose results. Unfortunately, in one of the RCTs and the five cohort studies, the types and doses of statins used were not specified. Study sizes ranged from 101 to 372 patients, for a total of 1,607 patients.…”

Association between left atrial stiffness and aortic plaque thickness in hypertensive patients with stroke

“…It is clearly demonstrated that, oxidative stress and inflammation have a significant role in developing left atrial fibrosis and remodeling, which causes left atrial myocardium as susceptible substrate for the occurrence of AF . Likewise, it is widely accepted that oxidative stress and inflammation are also of the important pathophysiologies of atherosclerotic progression …”

Association Between Plaque Thickness of the Thoracic Aorta and Recurrence of Atrial Fibrillation After Ablation

“…It has been suggested that AF and atherosclerosis share common risk factors such as age, hypertension and DM 12)13). Furthermore, several reports demonstrated that oxidative stress and inflammation can play an important role in fibrosis and atrial structural remodeling, which results in the occurrence of AF 23-25). Oakes et al26) reported that the degree of fibrosis of LA myocardial tissue estimated on delayed enhancement magnetic resonance imaging is an independent predictor of recurrence of AF after ablation.…”