title: Renin-angiotensin system blockade is associated with the long-term protection against cardiac remodeling after cardioversion in hypertensive patients with atrial fibrillation.
abstract: Atrial fibrillation (AF) is the most common arrhythmia, and renin-angiotensin system blockade (RAS-B) may be favorable for AF because of its effect on cardiac remodeling. However, effects of RAS-B on AF in hypertensive patients are controversial. Thus, in this study, we investigated the long-term effects of RAS-B on cardiac remodeling and rhythm control after electrical cardioversion for hypertensive patients with persistent AF. We studied 27 consecutive hypertensive patients with persistent AF (duration > one week) who received electrical cardioversion and once recovered to sinus rhythm. Blood pressure of the patients was controlled by medication including RAS-B. The patients were divided into those who were pre-treated with RAS-B (n = 10) for at least two months before electrical cardioversion and those without RAS-B (n = 17). We performed echocardiography before electrical cardioversion and 3 years after electrical cardioversion in all patients and compared the differences in echocardiographic cardiac remodeling parameters, including left atrial dimension, left ventricular end-diastolic dimension and left ventricular ejection fraction. The AF recurrence-free ratio during the follow-up period was significantly higher in the RAS-B group than in the non-RAS-B group, judged by Kaplan-Meier analysis (60 vs. 24%, P = 0.01). All cardiac remodeling parameters in the RAS-B group showed better values than those in non-RAS-B group (each parameter, P < 0.05), supporting the beneficial effects of RAS-B on AF in hypertensive patients. In hypertensive patients with AF, pre-treatment with RAS-B before electrical cardioversion can prevent cardiac remodeling for 3 years and maintain sinus rhythm.
authors.affiliation: Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Egami
authors.forename: Masami
authors.initials: M
authors.lastname: Nishino
authors.forename: Masayuki
authors.initials: M
authors.lastname: Taniike
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Makino
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kato
authors.forename: Ryu
authors.initials: R
authors.lastname: Shutta
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamaguchi
authors.forename: Jun
authors.initials: J
authors.lastname: Tanouchi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004554:Electric Countershock; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012084:Renin-Angiotensin System / Q000187:drug effects*; D013997:Time Factors; D014463:Ultrasonography; D020257:Ventricular Remodeling / Q000502:physiology*