Does treatment with ACE inhibitors or angiotensin II receptor antagonists prevent atrial fibrillation after dual chamber pacemaker implantation?
OBJECTIVE
A retrospective observational study was performed to test the hypothesis that a lower incidence of atrial fibrillation (AF) would be observed in patients treated with either angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists (AIIRAs) than those without these drugs, 1-year following implantation of a dual chamber pacemaker for all indications.


METHODS
One hundred and sixty consecutive patients who underwent implantation of a dual chamber pacemaker between January and August 2002 were identified and their case notes were retrospectively analysed. The primary endpoint was the presence of persistent AF (confirmed by 12-lead ECG recorded from the visit to the pacemaker clinic) at 12-month follow-up.


RESULTS
Overall, 8% patients developed new onset persistent AF at 1-year follow-up. The incidence of AF at 1-year was 4% in patients treated with ACE inhibitors, 8% in patients taking AIIRAs or 5% on either drug. Although a trend towards a higher incidence of AF was observed at 1-year (10%) in patients not receiving either of these drugs, this was not statistically significant (P = 0.21, drug vs. no drug). The incidence of AF in patients with a previous history of paroxysmal AF or cardioversion was significantly higher (23%) than those patients without (5%), P < 0.0001. An odds ratio (95% CI) of 7.9 (2.3-27.8) was obtained.


CONCLUSIONS
To confirm these interesting initial results and to investigate this important relationship further, larger prospective randomised controlled studies are required.
Williams
Simon G
SG
The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK. simongwilliams@hotmail.co.uk
Connelly
Derek T
DT
Jackson
Mark
M
Bennett
Anthony
A
Albouaini
Khaled
K
Todd
Derick M
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors