title: Angiotensin-converting enzyme inhibitors as adjunctive therapy in patients with persistent atrial fibrillation.
abstract: OBJECTIVE
  The purpose of the current study was to assess the effect of angiotensin-converting enzyme inhibitor (ACEI) therapy in facilitating cardioversion from persistent atrial fibrillation (AF) and maintaining sinus rhythm.
  
  
  BACKGROUND
  Pharmacologic therapy and electrical cardioversion for AF are often unsuccessful in maintaining long-term sinus rhythm.
  
  
  METHODS
  The current study, a 1-year, prospective follow-up, comprised 47 patients with persistent AF undergoing electrical cardioversion. Patients receiving ACEI were compared with those receiving other medications. The study end point was the number of defibrillation attempts required for atrial defibrillation and the number of hospital admissions. A secondary end point was change in signal-averaged P-wave duration (SAPD) 1 year after successful electrical cardioversion.
  
  
  RESULTS
  Of those admitted and requiring electrical defibrillation, the number of defibrillation attempts required for successful cardioversion was significantly less in the ACEI group (P <.001). The incidence rate ratio for admissions comparing recipients of ACEI with others was 0.14 (P =.03). Patients receiving ACEI therapy had significantly lower SAPD at 1 year when compared with the no-ACEI group (135 ms +/- 3 vs 150 ms +/- 2, P =.002).
  
  
  CONCLUSIONS
  The use of long-term ACEI therapy facilitated electrical defibrillation in patients with persistent AF. ACEI therapy also reduced SAPD, suggesting amelioration of the arrhythmogenic substrate. Furthermore, we confirmed that SAPD is prolonged in patients with persistent AF.
authors.affiliation: Department of Cardiology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom.
authors.forename: Azfar G
authors.initials: AG
authors.lastname: Zaman
authors.forename: Mark T
authors.initials: MT
authors.lastname: Kearney
authors.forename: Clyde
authors.initials: C
authors.lastname: Schecter
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Worthley
authors.forename: James
authors.initials: J
authors.lastname: Nolan
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011446:Prospective Studies; D015203:Reproducibility of Results
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors