Effects of captopril on ventricular arrhythmias in the early and late phase of suspected acute myocardial infarction: Randomized, placebo-controlled substudy of ISIS-4

Abstract

The antiarrhythmic effect of oral captopril was studied during the early (day 3) and late (day 14) phase of acute myocardial infarction among 304 patients in a randomized placebo-controlled substudy of ISIS-4. Ventricular arrhythmias (ventricular ectopic beats per hour) occurred significantly less frequently among captopril-allocated patients than among those allocated placebo at day 3 (logarithmic scale: 0.48 +/- 0.8 captopril vs 0.84 +/- 1.3 placebo; P < 0.003) and at day 14 (0.51 +/- 1.0 vs 0.77 +/- 1.3; P < 0.05). The number of patients with frequent ventricular arrhythmias (more than 10 ventricular ectopic beats per hour) was also significantly lower among those allocated captopril at day 3 (7.3% vs 14.4%; P < 0.05) and at day 14 (7.3% vs 14.8%; P < 0.05). These results support the hypothesis that the activation of the renin-angiotensin-aldosterone and sympathetic system may underlie heart rhythm disturbances in acute myocardial infarction, and that early use of converting enzyme inhibitor therapy may ameliorate these disturbances.

Antiarrhythmic effect of carvedilol after acute myocardial infarction

“…None of these studies, however, focused on patients with substantial left ventricular systolic dysfunction; indeed, it seems that high-risk patients were excluded from these studies (22,23). Furthermore, these studies were conducted before the benefits of ACE inhibitors, one of which is to reduce ventricular arrhythmias, had been established (19,30,31). We were able to confirm that carvedilol reduced ventricular arrhythmias, even in high-risk patients treated with an ACE inhibitor.…”

Statins as Anti‐Arrhythmics: A Systematic Review Part II: Effects on Risk of Ventricular Arrhythmias

“…AngiotensinConverting Enzyme inhibitors and omega-3 fatty acids, for example, have been shown to decrease the incidence of VA 22 and SCD, 23 respectively.…”

Inhibition of the Renin-Angiotensin System and Atrial Fibrillation in Heart Failure

“…They have been shown to suppress ventricular ectopic activity, but they also reduce the circulating level of angiotensin II, thereby decreasing peripheral resistance, alleviating the sympathetic nervous strain and reducing the load imposed on the heart [54,55] . Despite their truly haemodynamic effects, clinical data suggest a direct impact of ACE inhibition on AF development.…”