title: Prevention of recurrent atrial fibrillation with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers: a systematic review and meta-analysis of randomized trials.
abstract: BACKGROUND
  Controversy persists regarding the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in the prevention of recurrent atrial fibrillation (AF). We performed a meta-analysis of randomized controlled trials (RCTs), not designed a priori to test this hypothesis, to explore whether ACEs and ARBs reduce recurrent AF.
  
  
  METHODS
  We performed a systematic literature search for RCTs using ACEIs or ARBs and providing data on the outcome of recurrent AF. Statistical heterogeneity across the trials was tested using the Cochran Q statistic and I(2) was computed to quantify heterogeneity. A 2-sided α error of less than .05 was considered statistically significant (P < .05).
  
  
  RESULTS
  The analysis was based on 8 RCTs including 2323 patients. The Mantel-Haenszel random-effect model was used to calculate relative risk (RR) for studies using ACEIs or ARBs, and for studies using ARBs. The fixed-effect model was used to calculate RR for studies using ACEIs. Meta-analysis of the studies revealed that ACEIs or ARBs significantly reduced the incidence of recurrent AF (RR, 0.611; 95% CI, 0.441-0.847; P = .003). The RR for recurrent AF was 0.643 (95% CI, 0.439-0.941; P = .023) for studies using ARBs and 0.54 (95% CI, 0.377-0.80; P = .002) for studies using ACEIs.
  
  
  CONCLUSIONS
  In this meta-analysis of RCTs not designed a priori to test the hypothesis, ACEs and ARBs were associated with a significant reduction in recurrent AF. Large-scale randomized trials designed a priori to test the hypothesis are necessary to complete the totality of evidence.
authors.affiliation: Division of Cardiology, Department of Medicine, The Chicago Medical School, North Chicago, IL 60064, USA. bhur@sinai.org
authors.forename: Rohit
authors.initials: R
authors.lastname: Bhuriya
authors.forename: Mukesh
authors.initials: M
authors.lastname: Singh
authors.forename: Ankur
authors.initials: A
authors.lastname: Sethi
authors.forename: Janos
authors.initials: J
authors.lastname: Molnar
authors.forename: Amol
authors.initials: A
authors.lastname: Bahekar
authors.forename: Param Puneet
authors.initials: PP
authors.lastname: Singh
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khosla
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D000818:Animals; D001281:Atrial Fibrillation / Q000517:prevention & control*; D006801:Humans; D015233:Models, Statistical; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors