Impact of angiotensin-converting enzyme-inhibitors and angiotensin receptor blockers on long-term outcome of catheter ablation for atrial fibrillation.
OBJECTIVE
We hypothesized that modulation of the renin-angiotensin-aldosterone system (RAAS) improves success following catheter ablation for atrial fibrillation (AF).


RESULTS
We examined a prospective registry of consecutive patients undergoing catheter ablation of paroxysmal or persistent AF between November 2004 and December 2008. Patients were divided based on whether they were taking RAAS modulators at the time of their first procedure and examined on an intention to treat basis. There were 419 patients (222 paroxysmal and 197 persistent AF) who underwent 1.8 ± 0.9 procedures. Median follow-up from the last procedure was 1.7 (range 0.9-5.0) years. There were 142 patients on RAAS modulators; they were older, more likely to suffer from hypertension, diabetes, coronary disease, or left ventricular impairment. Overall, sinus rhythm was maintained in 73.2% of those taking RAAS modulators vs. 77.6% of those taking none (P = 0.304). Multivariate analysis showed no impact of RAAS modulators [hazard ratios (HR): 1.97, CI: 0.56-6.89, P = 0.290] but also no effect of hypertension, ischaemic heart disease, left ventricular impairment, or diabetes that should have confounded results (persistent AF was found to predict failure; HR: 0.34, CI: 0.14-0.84, P = 0.020). Subgroup analysis of patients with risk factors for developing AF (hypertension, coronary artery disease, left ventricular impairment, or diabetes) found no benefit in this context, with sinus rhythm maintained in 73.2% of those taking RAAS modulators compared with 69.9% of those taking none (P = 0.574).


CONCLUSIONS
Modulation of the RAAS does not appear to affect maintenance of sinus rhythm following catheter ablation of AF.
Tayebjee
Muzahir H
MH
Cardiology Research Department, Barts and The London NHS Trust and QMUL, St Bartholomew's Hospital, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK. mhtayebjee@hotmail.com
Creta
Antonio
A
Moder
Stefan
S
Hunter
Ross J
RJ
Earley
Mark J
MJ
Dhinoja
Mehul B
MB
Schilling
Richard J
RJ
D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents