Therapy with renin-angiotensin system blockers after pulmonary vein isolation in patients with atrial fibrillation: who is a responder?
OBJECTIVE
The data on anti-arrhythmic effect of renin-angiotensin-aldesteron system blockers (RASB) in patients with atrial fibrillation (AF) are controversially discussed. The goal of this analysis was to identify cohort of patients with AF and hypertension, who may have benefit from RASB therapy after pulmonary vein isolation (PVI).


METHODS
A total of 284 patients with AF and hypertension (paroxysmal AF [PAF]= 218, male = 185, age = 61 years, left ventricular ejection fraction = 60%, coronary artery disease = 42) considered for PVI were included. The patients with PAF were stratified according to time spent in AF (AF burden) within 3 months prior to admission (</> 500 hours). Further patients were divided into two groups: (1) low-burden AF; (2) high-burden AF (PAF and persistent AF). In 195 patients, RASB therapy was administered. A 7-day continuous Holter electrocardiogram was performed after discharge, every 3 months thereafter and by symptoms.


RESULTS
Preventive effect of RASB was revealed in whole group (112 out of 195 [57%] vs 36 out of 89 [40%]; P = 0.025) and was more pronounced in patients with low-burden AF (79 out of 112 [71%] receiving RASB vs 27 out of 55 [49%] being on other drugs; P = 0.013). However, efficiency of RASB failed in patients with high-burden AF (33 out of 83 on RASB [40%] vs nine out of 34 on other drugs [27%]; P = 0.328).


CONCLUSIONS
Our data suggest that RASB appears to protect against AF recurrences after PVI in patients with low-burden paroxysmal AF. These results should be tested in a prospective study.
Berkowitsch
Alexander
A
Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany. a.berkowitsch@kerckhoff-klinik.de
Neumann
Thomas
T
Kuniss
Malte
M
Janin
Sebastien
S
Wojcik
Maciej
M
Zaltsberg
Sergej
S
Mitrovic
Veselin
V
Pitschner
Heinz F
HF
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D017115:Catheter Ablation; D015331:Cohort Studies; D004232:Diuretics / Q000627:therapeutic use; D015716:Electrocardiography, Ambulatory; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D055502:Secondary Prevention; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D004232:Diuretics