Impact of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on the long-term outcome after pulmonary vein isolation for paroxysmal atrial fibrillation.
OBJECTIVE
The effect of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARBs) on the long-term outcome after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) is unknown.


METHODS
This matched-pair study included 102 patients with PAF treated with ACE-I or ARBs (group 1) and 102 control subjects (group 2) after standardized PVI. Tele-ECG recorders were used to detect the end point of the first PAF recurrence after a 3-month blanking period.


RESULTS
Median follow-up was 2.1 years (range 0.3-6.3). In group 1, 51 (50%) patients suffered recurrences, with a mean time to recurrence of 3.2 years (95% CI 2.6-3.8). In group 2, 67 (65.7%) patients presented PAF after a mean period of 2.2 years (95% CI 1.7-2.8; p = 0.009). A second ablation was performed in 31 (50%) patients from the treatment group and in 48 (66.7%) patients from the control group (p = 0.02). Multivariate Cox analysis showed treatment with ACE-I and ARBs to be the only significant predictor of a reduced recurrence rate (HR 0.49, 95% CI 0.32-0.75).


CONCLUSIONS
ACE-I and ARBs were effective for the preservation of sinus rhythm after PAF ablation, and they reduced the reablation rate.
Klemm
Hanno U
HU
Department of Cardiology, Heart Center Dortmund, Dortmund, Germany. hanno.klemm@klinikumdo.de
Heitzer
Thomas
T
Ruprecht
Ute
U
Meinertz
Thomas
T
Ventura
Rodolfo
R
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 / Q000453:epidemiology / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D016208:Databases, Factual; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000601:surgery*; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors