Angiotensin-converting enzyme inhibitor suppresses the incidence of prolonged and fractionated right atrial electrograms.
BACKGROUND
Although prolonged and fractionated right atrial electrograms have been reported as predictors of the development of chronic atrial fibrillation in patients with paroxysmal atrial fibrillation (PAF), the effects of angiotensin-converting enzyme inhibitor (ACEI) on these electrophysiologic abnormalities remain unknown. The purpose of this study was to evaluate whether ACEI influences these electrophysiologic abnormalities of atrial muscle in patients with PAF.


METHODS
While taking oral ACEI for hypertension, 12 patients (ACEI group) with PAF underwent electrophysiologic study (EPS). Catheter mapping of 12 right atrial sites and right atrial extrastimulation were performed during sinus rhythm. Twenty-four age-matched patients with PAF but not taking oral ACEI were included as a control group.


RESULTS
The longest duration of the right atrial electrogram was significantly shorter and the maximum number of fragmented deflections per patient was significantly lower in the ACEI group than in the control group (79 +/- 15 ms vs 100 +/- 15 ms, P < 0.005; 5.5 +/- 1.9 vs 7.9 +/- 2.4, P < 0.001, respectively). The number of abnormal atrial electrograms per patient was significantly lower in the ACEI group than in the control group (0.5 +/- 1.4 vs 2.1 +/- 1.8, P < 0.05). The percentage of patients with at least one abnormal atrial electrogram was significantly lower in the ACEI group than in the control group (16.7% vs 79.2%, P < 0.0005).


CONCLUSIONS
ACEI use is associated with a decrease in the incidence of prolonged and fractionated right atrial electrograms in patients with PAF. In addition, we suggest that ACEI may help prevent PAF from becoming chronic.
Department of Cardiovascular Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
Riyako
R
Shibata
Kojiro
K
Nakao
Satoki
S
Fukae
Kiyotaka
K
Matsuo
Katsusuke
K
Yano
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D016009:Chi-Square Distribution; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric
D000806:Angiotensin-Converting Enzyme Inhibitors