Renin-angiotensin system inhibitors can suppress atrial fibrillation recurrence after encircling ipsilateral pulmonary vein isolation in patients with a non-dilated left atrium.
BACKGROUND
The purpose of this study was to investigate whether the effects of renin-angiotensin system inhibitors (RASIs) after encircling ipsilateral pulmonary veins isolation (EIPVsI) for atrial fibrillation (AF) differed between patients with non-dilated and dilated left atria.


METHODS
We retrospectively studied 292 consecutive patients (mean age=61±11 years, 75% males) who underwent successful EIPVsI for paroxysmal or persistent AF. RASIs' effects were compared between the patients with a non-dilated left atrium of <40 mm (n=178) and dilated left atrium of ≥40 mm (n=114).


RESULTS
During a mean follow-up period of 18.9±12.7 months, AF recurred in 38 (21.4%) and 45 (39.5%) patients with non-dilated and dilated left atria, respectively. A multivariate Cox proportional analysis revealed that treatment with RASIs (hazard ratio (HR) 0.30, 95% confidence interval (CI) =0.13-0.66, p=0.003), the duration of AF (HR 1.08/year, 95% CI=1.01-1.16, p=0.03), a history of hypertension (HR 2.86, 95% CI=1.21-6.85, p=0.02) and the left ventricular ejection fraction (HR 0.54/10%↑, 95% CI=0.34-0.87, p=0.01) were associated with AF recurrences in patients with a non-dilated left atrium. On the other hand, only the duration of AF (HR 1.11/year, 95% CI=1.01-1.21, p=0.03) was associated with AF recurrences in those with a dilated LA, and RASIs had no effect on AF recurrences (p=0.65).


CONCLUSIONS
RASIs suppressed AF recurrences after EIPVsI only in patients with a non-dilated left atrium.
Department of Cardiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
Masateru
M
Takigawa
Takumi
T
Yamada
Yukihiko
Y
Yoshida
Monami
M
Ando
Kiyotake
K
Ishikawa
Yutaka
Y
Aoyama
Takashi
T
Yamamoto
Natsuo
N
Inoue
Yasushi
Y
Tatematsu
Mamoru
M
Nanasato
Kazuo
K
Kato
Naoya
N
Tsuboi
Haruo
H
Hirayama
D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000187:drug effects / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011667:Pulmonary Veins / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012084:Renin-Angiotensin System / Q000187:drug effects*; D014664:Vasodilation / Q000187:drug effects
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors