title: Renin-angiotensin system inhibitors for prevention of recurrent atrial fibrillation: a meta-analysis.
abstract: BACKGROUND
  Conflicting results exist now on the clinical utility of renin-angiotensin system (RAS) inhibitors in patients with atrial fibrillation (AF). This study aimed to elaborate the efficacy and safety of RAS blockade on preventing the relapse of AF by a meta-analysis based on randomised controlled trials (RCTs).
  
  
  METHODS
  We searched Medline, ISI web of science and Cochrane databases through Jan 2012. We included RCTs comparing RAS inhibition treatment vs. placebo or alternative therapy after cardioversion of persistent AF or conventional medical therapy for paroxysmal AF and reporting outcome of recurrent AF. Odds ratios (OR) were calculated using a random effects model.
  
  
  RESULTS
  Fifteen trials involving 3972 AF patients were included in the analysis. The pooling analysis showed that RAS inhibitors significantly reduced the recurrence of AF compared with non-RAS inhibitors (OR=0.50, 95% CI: 0.37-0.69, p<0.01), and the beneficial effect was shown consistently both in patients with paroxysmal and in those with persistent AF after cardoversion. However, administration of RAS inhibitors did not provide a greater survival advantage and a lower incidence of adverse effects than the control (OR=1.17, 95% CI, 0.65-2.10, p=0.59; OR=0.94, 95% CI: 0.65-1.35, p=0.73 respectively). In addition, clinical factors potentially affecting AF relapsing had no pronounced impacts on the above clinical outcomes.
  
  
  CONCLUSIONS
  Based on the currently available data, inhibition of RAS is effective, safe and well tolerated for preventing the recurrence of AF.
authors.affiliation: Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China. litiejun@medmail.com.cn
authors.forename: T-J
authors.initials: TJ
authors.lastname: Li
authors.forename: W-D
authors.initials: WD
authors.lastname: Zang
authors.forename: Y-L
authors.initials: YL
authors.lastname: Chen
authors.forename: N
authors.initials: N
authors.lastname: Geng
authors.forename: S-M
authors.initials: SM
authors.lastname: Ma
authors.forename: X-D
authors.initials: XD
authors.lastname: Li
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004554:Electric Countershock; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents