Inhibition of the renin-angiotensin-aldosterone system prevents and cures atrial fibrillation

Abstract

Background: Atrial fibrillation (AF) is a type of arrhythmia that represents a severe health hazard. The current therapies for AF have achieved success in some conditions. However, because the mechanisms underlying the occurrence and development of this disease remain unclear, the current treatment for AF often does not achieve the desired outcomes. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), which exert robust effects on specific cardiovascular diseases, are widely used in the clinic. Several studies are focusing on the effect of ACEIs/ARBs on the prevention and cure of AF. Some systematic reviews have obtained different and even opposite results. An overview is required to obtain a conclusion and provide strong evidence to guide clinical work. Methods: We searched 5 databases, including MEDLINE, EMBASE, Cochrane Library, Web of Science, and CNKI (Chinese), and selected relevant reviews that passed the assessment we performed. Then, we synthesized the data for each result from the included reviews and obtained conclusions. Results: ACEIs/ARBs prevented new-onset AF and AF after heart failure. ACEIs/ARBs performed well in the prevention of secondary AF, especially postoperative AF. However, for patients suffering from hypertension and myocardial infarction, ACEIs/ARBs were not the right choices for preventing AF. Conclusions: We suggest that physicians select ACEIs/ARBs as an anti-AF therapy for patients with heart failure due to their additional benefits. Moreover, for patients who have suffered AF, ACEIs/ARBs may be a routine drug for secondary prevention.

Prognostic Impact and Predictors of New-Onset Atrial Fibrillation in Heart Failure

“…Previous studies have reached divergent conclusions about the efficacy of RAS inhibition for the primary prevention of AF. Although some studies have shown a reduction in new-onset events with either ACEI or ARB therapy [17], others have not demonstrated a clear benefit [18]. Furthermore, previous studies have shown that MRAs [19,20], betablockers [21], and statins [22] could significantly reduce the risk of NOAF in patients with HF history.…”

The Association Between Rheumatoid Arthritis and Atrial Fibrillation: Epidemiology, Pathophysiology and Management

“…Renin angiotensin system (RAS) is suggested to play a key role in the occurrence and development of AF through structural and electrical remodeling. 61 , 62 In addition, RAS blockade therapy has been shown to reduce the relative risk of recurrent AF by 39%. 63 Angiotensin-converting enzyme (ACE) and angiotensin II (Ang II) are the major components of RAS and there is intracellular RAS in cardiac myocytes.…”

“…[28][29][30]124 The major pathophysiological mechanisms of AF include atrial remodeling, autonomic nervous system dysfunction, activation of RAS, endothelial dysfunction, increased EAT thickness, higher adiponectin concentrations and IR. 31,32,53,55,62,68,69,81,84 RA is widely involved in these pathophysiological processes. Controversially, some studies have shown an absence of association between RA and the occurrence of new-onset AF.…”

Sex-specific association of cardiovascular drug doses with adverse outcomes in atrial fibrillation

“…However, the evidence for a benefit of beta-blockers in patients with AF only is limited to ventricular rate control and for prevention of symptomatic AF (3)(4)(5). RAS inhibitors may prevent incident and recurrent episodes of AF in some populations, for example AF recurrence in Asian but not in European or American populations (6,7).…”