title: Inefficiency of renin-angiotensin inhibitors in preventing atrial fibrillation in patients with a normal heart.
abstract: OBJECTIVE
  Recent scientific evidence has emphasized the possible role of inhibitors of the renin-angiotensin system in preventing arrhythmic relapses in patients with paroxysmal or persistent atrial fibrillation and co-existing left ventricular hypertrophy or left ventricular dysfunction.
  
  
  METHODS
  In order to verify the effects of these drugs on patients with a normal heart, we collected a series of 187 patients admitted to our division of cardiology for paroxysmal or persistent atrial fibrillation. All patients underwent cardioversion (with antiarrhythmic drugs and/or by electrical cardioversion) and were discharged in sinus rhythm. Episodes of recurrent arrhythmia were recorded during a mean follow-up period was 2 years. Patients were subdivided into 2 groups according to therapy: group 1 comprised patients receiving renin-angiotensin system inhibitors, group 2 comprised those not receiving therapy with these agents. All 91 patients in group 1 and 76 of those in group 2 had hypertension. Among the 91 patients in the group 1, 55 were treated with angiotensin-converting enzyme (ACE) inhibitors and 36 with angiotensin receptor blockers. There were no statistically significant differences in cardiovascular risk factors or antiarrhythmic drug use between the 2 groups.
  
  
  RESULTS
  In group 1, 83% of patients experienced <2 recurrences of atrial fibrillation during the follow-up period, while 17% had >2 episodes. In group 2, 86% of patients experienced <2 relapses during the follow-up period, while the remaining 14% had >2 relapses. There was no statistically significant difference between the 2 groups (P=0.85). A subgroup analysis showed that treatment with angiotensin receptor blockers, beta-blockers, diuretics, and calcium-channel blockers brought no advantage in sinus rhythm maintenance.
  
  
  CONCLUSIONS
  In our sample of hypertensive patients with a healthy heart, treatment with ACE inhibitors showed no statistically significant advantage in the prevention of atrial fibrillation relapses.
authors.affiliation: Department of Cardiology, University of Palermo, Palermo, Italy. Giovanni.fazio-aaaa@poste.it
authors.forename: G
authors.initials: G
authors.lastname: Fazio
authors.forename: C
authors.initials: C
authors.lastname: Pizzuto
authors.forename: L
authors.initials: L
authors.lastname: Sutera
authors.forename: D
authors.initials: D
authors.lastname: Guttilla
authors.forename: G
authors.initials: G
authors.lastname: Di Gesaro
authors.forename: C
authors.initials: C
authors.lastname: Cascio
authors.forename: G
authors.initials: G
authors.lastname: Novo
authors.forename: P
authors.initials: P
authors.lastname: Assennato
authors.forename: S
authors.initials: S
authors.lastname: Novo
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000517:prevention & control* / Q000628:therapy; D004359:Drug Therapy, Combination; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors