Prevention of new-onset atrial fibrillation and its predictors with angiotensin II-receptor blockers in the treatment of hypertension and heart failure.
Atrial fibrillation is the most frequent occurring sustained cardiac arrhythmia and it is related to common cardiac disease conditions. Hypertension increases the risk of atrial fibrillation by approximately two-fold and, because of the high prevalence of hypertension, it accounts for more cases of atrial fibrillation than any other risk factor. In recent years, there are two large hypertension trials (LIFE and VALUE) and two large heart failure trials (CHARM and Val-HeFT) reporting the beneficial effect of angiotensin II-receptor blockers (ARBs) on new-onset atrial fibrillation, beyond the blood pressure-lowering effect. Blockade of the renin-angiotensin system may prevent left atrial dilatation, atrial fibrosis, dysfunction and conduction velocity slowing. Some studies also indicate direct anti-arrhythmic properties. This review aims to consider the preventive effect of ARBs on new-onset atrial fibrillation observed in recent reports from these trials, and to discuss possible mechanisms of the beneficial effect of angiotensin II-receptor blockade.
Aksnes
Tonje A
TA
Department of Cardiology, Ullevaal University Hospital, N-0407 Oslo, Norway. tonjeamb.aksnes@ulleval.no
Flaa
Arnljot
A
Strand
Arne
A
Kjeldsen
Sverre E
SE
D017677:Age Distribution; D000367:Age Factors; D000375:Aging; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D003327:Coronary Disease / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006339:Heart Rate; D006349:Heart Valve Diseases / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000150:complications; D008297:Male; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012008:Recurrence; D012084:Renin-Angiotensin System / Q000187:drug effects; D012107:Research Design; D012307:Risk Factors; D012727:Sex Characteristics; D017678:Sex Distribution; D012737:Sex Factors; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D000889:Anti-Arrhythmia Agents