The Effects of Statins and Renin‐Angiotensin System Blockers on Atrial Fibrillation Recurrence Following Antral Pulmonary Vein Isolation

Chekakie, M. Obadah Al; Akar, Joseph G.; Wang, Fei; Muradi, Hazem Al; Wu, Joseph M.; Santucci, Peter; Varma, Niraj; Wilber, David J.

doi:10.1111/j.1540-8167.2007.00887.x

Cited by 66 publications

(71 citation statements)

References 41 publications

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“…In particular, isolation of the pulmonary veins was the end point for a minority (35%) of the patients. A similar study by Al Chekakie et al [24] demonstrated a favorable outcome with ARBs, though it was not statistically significant due to a limited number of patients. As in the Richter et al [23] study no effect could be attributed to the intake of statins.…”

Section: Discussionmentioning

confidence: 91%

Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on the Long-Term Outcome after Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

Klemm

Heitzer²,

Ruprecht³

et al. 2010

Cardiology

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Objectives: The effect of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARBs) on the long-term outcome after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) is unknown. Methods: This matched-pair study included 102 patients with PAF treated with ACE-I or ARBs (group 1) and 102 control subjects (group 2) after standardized PVI. Tele-ECG recorders were used to detect the end point of the first PAF recurrence after a 3-month blanking period. Results: Median follow-up was 2.1 years (range 0.3–6.3). In group 1, 51 (50%) patients suffered recurrences, with a mean time to recurrence of 3.2 years (95% CI 2.6–3.8). In group 2, 67 (65.7%) patients presented PAF after a mean period of 2.2 years (95% CI 1.7–2.8; p = 0.009). A second ablation was performed in 31 (50%) patients from the treatment group and in 48 (66.7%) patients from the control group (p = 0.02). Multivariate Cox analysis showed treatment with ACE-I and ARBs to be the only significant predictor of a reduced recurrence rate (HR 0.49, 95% CI 0.32–0.75). Conclusion: ACE-I and ARBs were effective for the preservation of sinus rhythm after PAF ablation, and they reduced the reablation rate.

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Section: Discussionmentioning

confidence: 91%

Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on the Long-Term Outcome after Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

Klemm

Heitzer²,

Ruprecht³

et al. 2010

Cardiology

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“…Al Chekakie et al retrospectively evaluated the recurrence rate of AF in 177 (mean age 56 ± 11 years) consecutive patients who underwent catheter ablation for paroxysmal (132 patients) or persistent (45 patients) AF [68]. Recurrence of AF was defined as an electrocardiographically documented episode lasting at least 30 s, irrespective of symptoms.…”

Section: In Patients Treated With Catheter Ablationmentioning

confidence: 99%

Angiotensin II receptor blockers in the prevention of atrial fibrillation

Barra

Silvestri²,

Vitagliano³

et al. 2009

Expert Opinion on Pharmacotherapy

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Atrial fibrillation (AF) is the most common sustained arrhythmia. While antiarrhythmic agents and electrical cardioversion are highly effective in restoring sinus rhythm, the results obtained in prevention of recurrences are disappointing. Recently, angiotensin II has been recognized as a key factor in atrial structural and electrical remodeling associated with AF. So there are several potential mechanisms by which inhibition of the renin-angiotensin-aldosterone system may reduce AF. In this review, we report the results of studies evaluating the effect of angiotensin II receptor blockers (ARBs) in various clinical settings (i.e., lone AF, hypertension, high-risk patients, congestive heart failure, secondary prevention). However, many of these studies are small and retrospective and have a limited follow-up; moreover, since AF is related to several causes, chiefly heart diseases, patients with different characteristics have often been enrolled. Thus, it is not surprising that the results obtained are frequently conflicting. With these limitations and considering only the results of larger studies with longer follow-up, ARBs are effective in preventing AF in patients with congestive heart failure or hypertension with left ventricular hypertrophy or coronary artery/cerebrovascular disease. In any case, the use of ARBs is not recommended at present in clinical practice to prevent AF.

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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.…”

Section: La Size and Fibrosismentioning

confidence: 99%

“…[16][17][18][19][20][21] A few retrospective trials have demonstrated that the routine use of statins, ACEIs or ARBs did not improve the outcome of AF ablation among patients with drug-resistant paroxysmal or persistent. 16,17 Tayebjee et al also recently identified that RASIs had no beneficial effect on the long-term sinus maintenance after catheter ablation of PAF and PerAF. 18 Zheng et al showed that RASIs could not prevent AF recurrences in patients with chronic AF.…”

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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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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The Effects of Statins and Renin‐Angiotensin System Blockers on Atrial Fibrillation Recurrence Following Antral Pulmonary Vein Isolation

Cited by 66 publications

References 41 publications

Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on the Long-Term Outcome after Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on the Long-Term Outcome after Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

Angiotensin II receptor blockers in the prevention of atrial fibrillation

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

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