Pretreatment with ACE inhibitors improves acute outcome of electrical cardioversion in patients with persistent atrial fibrillation.
BACKGROUND
Persistent atrial fibrillation (AF) is difficult to treat. In the absence of class I or III antiarrhythmic drugs sinus rhythm is maintained in only 30% of patients during the first year after electrical cardioversion (ECV). One of the remodeling processes induced by AF is fibrosis, which relates to inducibility and maintenance of AF. The renin-angiotensin system may play a important role in this. The aim of this study was to investigate the role of angiotensin-converting enzyme (ACE) inhibitor use on efficacy of ECV, and occurrence of subacute recurrences.


METHODS
One hundred-seven consecutive patients with persistent AF underwent ECV. In twenty-eight (26%) patients ACE inhibitors had been started before initiation of the present episode of AF ('pre-treated' patients).


RESULTS
ECV was successful in 96% of patients who were on ACE inhibitors before start of the present episode of AF compared to 80% of the patients not pre-treated (p = 0.04). After 1 month of follow-up 49% of the pre-treated patients and 50% of those not pre-treated with ACE inhibition were still in sinus rhythm (p=ns). Multivariate analysis showed that pre-treatment with ACE inhibitors and a smaller left atrial size were independent predictors of successful ECV (OR = 5.8, C.I. 1.3-26.1, and OR = 5.6, C.I. 1.2-25.3, respectively).


CONCLUSIONS
Pre-treatment with ACE inhibitors may improve acute success of ECV but does not prevent AF recurrences.
Van Noord
Trudeke
T
Department of Cardiology, Thoraxcenter, University Hospital Groningen, P.O. Box 30,001, 9700RB Groningen, The Netherlands. t.van.noord@thorax.azg.nl
Crijns
Harry J G M
HJ
van den Berg
Maarten P
MP
Van Veldhuisen
Dirk J
DJ
Van Gelder
Isabelle C
IC
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D003324:Coronary Artery Disease / Q000453:epidemiology; D004554:Electric Countershock; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015999:Multivariate Analysis; D011292:Premedication; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology
D000806:Angiotensin-Converting Enzyme Inhibitors