Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation Results of a prospective and controlled study

Ueng, Kwo‐Chang; Tsai, Tsung-Po; Yu, Wen-Chung; Tsai, Chin‐Feng; Lin, Ming‐Cheng; Chan, Kuei-Chuan; Chen, Chung-Yin; Wu, Dongshuang; Lin, Chung‐Sheng; Chen, Shih‐Ann

doi:10.1016/j.ehj.2003.08.014

Cited by 247 publications

(73 citation statements)

References 42 publications

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“…The observation was similar to previous studies showing that ACEI and ARB were effective in reducing LV mass in patients with hypertension [32], and concordant with the results of recent clinical trials showing the efficacy of ACEI or ARB in the treatment of AF [33, 34]. …”

Section: Discussionsupporting

confidence: 79%

Evolution of Left Atrial Systolic and Diastolic Functions in Different Stages of Hypertension: Distinct Effects of Blood Pressure Control

Tsai¹,

Hwang²,

Shih³

et al. 2007

Cardiology

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Background: To evaluate the left atrial (LA) volume, and LA systolic (contractile) and diastolic (expansion) functions in different stages of hypertension with or without atrial fibrillation (AF), as well as the effects of good blood pressure control. Methods: A prospective observational study. Individuals including 22 normotensive controls, 23 patients with mild hypertension, 20 with severe hypertension, and 17 with hypertension and paroxysmal AF were recruited for paired echocardiography studies at baseline and 6 months after control of hypertension. Results: With increasing severity of hypertension, left ventricular (LV) diastolic function deteriorated with decreasing LV septal E′/A′ and increasing E/E′ ratios. LA expansion index was reduced in parallel. LA expansion index was correlated positively with LV E′/A′ (r = 0.43, p = 0.022) and inversely with LV E/E′ (r = 0.49, p = 0.009). Significant improvement of LV diastolic function and LA expansion index preceded the reduction of LA volume after blood pressure control. In patients with paroxysmal AF, LA volume reduction was more evident in patients receiving angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers. Conclusions: With progressive LV diastolic dysfunction in hypertension, there was a corresponding deterioration in LA diastolic function. Effective blood pressure control for 6 months improved LA diastolic function.

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Section: Discussionsupporting

confidence: 79%

Evolution of Left Atrial Systolic and Diastolic Functions in Different Stages of Hypertension: Distinct Effects of Blood Pressure Control

Tsai¹,

Hwang²,

Shih³

et al. 2007

Cardiology

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“…In clinical trials inhibition with an angiotensin II receptor antagonist or an ACE inhibitor diminishes the risk of AF relapse [14, 15]. …”

Section: Discussionmentioning

confidence: 99%

Raised Plasma Aldosterone and Natriuretic Peptides in Atrial Fibrillation

et al. 2006

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Background and Aims: During atrial fibrillation (AF), the renin-angiotensin-aldosterone system (RAAS) may be activated.In this study, our aim was to evaluate at a long-term follow-up visit the levels of plasma aldosterone and natriuretic peptides as markers of neurohormonal remodeling in patients with earlier, documented AF in relation to present heart rhythm, clinical data, and the left ventricular ejection fraction (LVEF). We hypothesized that increased levels of aldosterone and natriuretic peptides were significantly associated with present AF as markers of RAAS activation during the arrhythmia. Methods: We studied 158 patients with earlier ECG-documented AF followed by restored sinus rhythm (SR) attending a follow-up visit 2.6 years (mean) after primary inclusion. Results: At follow-up, 93 patients had SR. Heart rhythm at follow-up visit (SR/AF), plasma aldosterone, plasma N-terminal pro Brain Natriuretic Peptide (Nt- proBNP), plasma N-terminal pro Atrial Natriuretic Peptide (Nt-proANP), LVEF, medication, and clinical characteristics were recorded. Standard linear multiple regression analysis including age, sex, weight, hypertension, congestive heart failure, ischemic heart disease, present AF at follow-up, total duration of AF disease, ongoing medication, and the LVEF as explanatory variables showed that only ongoing treatment with diuretics was significantly associated (likelihood ratio test, p = 0.0057) with a raised log-transformed plasma aldosterone, although present AF at follow-up was related to a high aldosterone level (p = 0.09). For the natriuretic peptides, present AF at follow-up (p < 0.0001), age (p < 0.0001), female gender (p = 0.0047), ischemic heart disease (p = 0.0154), and ongoing treatment with sotalol (p = 0.0003) were all independently associated with high log-transformed plasma Nt-proANP. Likewise, present AF at follow-up (p = 0.0008) as well as age (p < 0.0001) were associated with high log-transformed plasma Nt-proBNP. Conclusions: In patients with earlier AF, AF at long-term follow-up visit was independently associated with raised levels of Nt-proANP and Nt-proBNP and to some extent with plasma aldosterone indicating neurohormonal activation during arrhythmia.

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“…A maximum dosage was taken by a minority (23%) of the group 1 patients. Although speculations remain regarding whether the effects could be intensified by a higher drug intake, prior studies on AF prevention used intermediate doses of the studied agents [9,11,12]. …”

Section: Discussionmentioning

confidence: 99%

“…Several experimental and clinical studies have addressed the influence of each of these drugs in various settings of new-onset [19,20,21] or recurrence of AF [12,22]. Trials emphasizing the influences on self-sustained persistent AF have correlated drug treatment with fewer recurrences after electric cardioversion [11,12]. In agreement with these studies, our data show divergence of the Kaplan-Meier plots at the first 12 months of follow-up.…”

Section: Discussionmentioning

confidence: 99%

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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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Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation Results of a prospective and controlled study

Abstract: The addition of enalapril to amiodarone decreased the rate of immediate and subacute arrhythmia recurrences and facilitated subsequent long-term maintenance of sinus rhythm after cardioversion of persistent AF.

Cited by 247 publications

References 42 publications

Evolution of Left Atrial Systolic and Diastolic Functions in Different Stages of Hypertension: Distinct Effects of Blood Pressure Control

Evolution of Left Atrial Systolic and Diastolic Functions in Different Stages of Hypertension: Distinct Effects of Blood Pressure Control

Raised Plasma Aldosterone and Natriuretic Peptides in 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

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