Prevention of Recurrent Lone Atrial Fibrillation by the Angiotensin-II Converting Enzyme Inhibitor Ramipril in Normotensive Patients

Belluzzi, Fabio; Sernesi, L; Preti, Paola; Salinaro, Francesco; Fonte, Maria Luisa; Perlini, Stefano

doi:10.1016/j.jacc.2008.08.071

Cited by 94 publications

(72 citation statements)

References 40 publications

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“…6,8,[16][17][18][19] On the other hand, a suppressive effect of RASIs on AF recurrences after PVI was demonstrated in patients with a relatively small LA. 15,20 The present study showed that the use of RASIs was closely associated with the AF recurrence-free rates in the patients with a non-dilated LA, but not at all in the patients with a dilated LA. It has been reported that LA dilatation correlates with the degree of 22 and both atrial dilation and fibrosis are only partially reversible after sinus rhythm is restored, 23,24 whereas short-term electrical remodelling is completely reversible.…”

Section: La Size and Fibrosismentioning

confidence: 48%

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Renin–angiotensin system inhibitors can suppress atrial fibrillation recurrence after encircling ipsilateral pulmonary vein isolation in patients with a non-dilated left atrium

Takigawa

Yamada

Yoshida

et al. 2012

J Renin Angiotensin Aldosterone Syst

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Introduction: The purpose of this study was to investigate whether the effects of renin-angiotensin system inhibitors (RASIs) after encircling ipsilateral pulmonary veins isolation (EIPVsI) for atrial fibrillation (AF) differed between patients with non-dilated and dilated left atria. Materials and methods: We retrospectively studied 292 consecutive patients (mean age=61±11 years, 75% males) who underwent successful EIPVsI for paroxysmal or persistent AF. RASIs' effects were compared between the patients with a non-dilated left atrium of <40 mm (n=178) and dilated left atrium of ≥40 mm (n=114). Results: During a mean follow-up period of 18.9±12.7 months, AF recurred in 38 (21.4%) and 45 (39.5%) patients with non-dilated and dilated left atria, respectively. A multivariate Cox proportional analysis revealed that treatment with RASIs (hazard ratio (HR) 0.30, 95% confidence interval (CI) =0.13-0.66, p=0.003), the duration of AF (HR 1.08/year, 95% CI=1.01-1.16, p=0.03), a history of hypertension (HR 2.86, 95% CI=1.21-6.85, p=0.02) and the left ventricular ejection fraction (HR 0.54/10%↑, 95% CI=0.34-0.87, p=0.01) were associated with AF recurrences in patients with a non-dilated left atrium. On the other hand, only the duration of AF (HR 1.11/year, 95% CI=1.01-1.21, p=0.03) was associated with AF recurrences in those with a dilated LA, and RASIs had no effect on AF recurrences (p=0.65). Conclusions: RASIs suppressed AF recurrences after EIPVsI only in patients with a non-dilated left atrium.

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Section: La Size and Fibrosismentioning

confidence: 48%

“…A small randomized study with ACEIs (ramipril) demonstrated a preventive effect on AF recurrences and LA remodelling, 15 whereas three recent prospective randomized studies did not. [6][7][8] Therefore, it has been increasingly recognized that RASIs alone cannot suppress AF in humans.…”

Section: Effect Of Rasis On Af Recurrences As Compared With Previous mentioning

confidence: 99%

Renin–angiotensin system inhibitors can suppress atrial fibrillation recurrence after encircling ipsilateral pulmonary vein isolation in patients with a non-dilated left atrium

Takigawa

Yamada

Yoshida

et al. 2012

J Renin Angiotensin Aldosterone Syst

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“…Furthermore, a recent report on the ON-TARGET study 4 indicated that 80 mg of telmisartan daily was equivalent to the ACE inhibitor ramipril, and was effective in preventing relapses of lone AF. 8 Further, with a dose of 10 mg daily, not only did it have an antihypertensive action but it also prevented atrial fibrillation. It is not Figure 1: Changes in the blood pressure (Left, A) and heart rate (Right, B) at baseline, during treatment with 40 mg (Low-dose group) and 80 mg (High-dose group) of telmisartan.…”

Section: Discussionmentioning

confidence: 98%

Effect of High-dose Telmisartan on the Prevention of Recurrent Atrial Fibrillation in Hypertensive Patients

Maeda¹,

Nishizaki²,

Yamawake³

et al. 2010

J.A.F.I.B

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It is well known that angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II type I receptor blockers (ARBs) are not only effective in treating hypertension but also in reducing the morbidity and mortality in various disease conditions including atrial fibrillation (AF), 1 coronaryCorresponding Address : Shingo Maeda, MD, 1-26-1 Kyonancho, Musashino-city, Tokyo, 180-8610, Japan. Effect of High-dose Telmisartan on the Prevention of Recurrent Atrial Fibrillation in Hypertensive Patients

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“…7 Previous meta-analyses based on several post hoc analyses of randomized controlled trials have shown that RAS blockers significantly reduced the risk of new-onset AF ranging from 28% to 49%, but this benefit was limited to patients with systolic left ventricular dysfunction or hypertension with LVH. 10,11 For secondary prevention of AF, several relatively small prospective randomized studies [12][13][14] have demonstrated that therapies with ACEI/ARBs conferred an additional benefit on risk of recurrent AF in these patients when coadministered with antiarrhythmic drug therapy, usually amiodarone, compared with antiarrhythmic drug alone. Whether RAS blockade could prevent recurrent AF in paroxysmal AF patients with minor underlying cardiac pathology, who are not undergoing cardioversion and do not receive antiarrhythmic drugs therapy or ACEIs, remains controversial.…”

Section: Main Findingsmentioning

confidence: 99%

Effect of Nifedipine Versus Telmisartan on Prevention of Atrial Fibrillation Recurrence in Hypertensive Patients

Fan

Ling

et al. 2013

Hypertension

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A trial fibrillation (AF) and hypertension are 2 prevalent and often coexisting conditions for which the incidence increases with age, and both are responsible for considerable cardiovascular morbidity and mortality.1 Hypertension is the most prevalent and independent risk factor of developing AF. 2,3 Previous studies demonstrated that hypertension was associated with left ventricular hypertrophy (LVH), impaired ventricular filling, left atrial (LA) structural changes, and slowing of atrial conduction velocity. 4 Meanwhile, antihypertensive treatment could reduce the risk of AF by reversing structural cardiac damage caused by hypertension. 5,6 All antihypertensive drugs reduce left ventricular and LA filling pressures and wall stress. However, preventing structural changes may be an effect specific to angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).Recently, angiotensin II has been recognized as a key factor in atrial structural and electric remodeling associated with AF.7 There are many potential mechanisms by which inhibition of the renin-angiotensin system (RAS) may reduce AF. Besides reducing the blood pressure (BP), per se, RAS blockers may prevent LA dilatation, atrial fibrosis, dysfunction, and conduction velocity slowing, and thereby have a greater effectiveness in patients with heart failure and LVH as seen in the meta-analysis by Schneider et al. 8 Furthermore, previous studies suggested that the ARB was more effective than the dihydropyridine calcium channel blocker in ameliorating atrial structural remodeling.9 Hence, RAS blockers might have more benefit beyond BP control than the dihydropyridine calcium channel blocker for hypertensive patients with paroxysmal AF.The present study was aimed to evaluate whether telmisartan-based treatment was superior to nifedipine-based treatment in hypertensive patients with paroxysmal AF after intensive BP control. Patients and Methods Study PopulationThe Nifedipine versus Telmisartan on Prevention of AF recurrence in hypertensive patients with AF trial (NTP-AF study, NCT01435161) was a prospective, randomized, open-label, parallel trial and was conducted from April 2006 to December 2011. All hypertensive patients with paroxysmal AF who were referred to the second affiliated Hospital of Chongqing Medical University were invited to participate in this study. All patients underwent history acquisition, physical examination, standard 12-lead ECG, 24-hour Holter monitoring, echocardiogram, chest X-ray, and thyroid and renal function tests before Abstract-It is controversial whether angiotensin II receptor blockers provide better protection than calcium antagonists against atrial fibrillation (AF) recurrence in hypertensive patients. This study was designed to compare the effect of nifedipine-and telmisartan-based antihypertensive treatments for preventing AF recurrence in hypertensive patients with paroxysmal AF. A total of 149 hypertensive patients with paroxysmal AF were randomized to nifedipine-or telmisartanbased antihyper...

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Prevention of Recurrent Lone Atrial Fibrillation by the Angiotensin-II Converting Enzyme Inhibitor Ramipril in Normotensive Patients

Abstract: Ramipril is effective in preventing relapses of LAF.

Cited by 94 publications

References 40 publications

Renin–angiotensin system inhibitors can suppress atrial fibrillation recurrence after encircling ipsilateral pulmonary vein isolation in patients with a non-dilated left atrium

Renin–angiotensin system inhibitors can suppress atrial fibrillation recurrence after encircling ipsilateral pulmonary vein isolation in patients with a non-dilated left atrium

Effect of High-dose Telmisartan on the Prevention of Recurrent Atrial Fibrillation in Hypertensive Patients

Effect of Nifedipine Versus Telmisartan on Prevention of Atrial Fibrillation Recurrence in Hypertensive Patients

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