CLINICAL RESEARCH: HEART RHYTHM DISORDER
Prevention of Atrial Fibrillation With Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
A Meta-Analysis
Jeff S. Healey, MD*,*,
Adrian Baranchuk, MD*,
Eugene Crystal, MD ,
Carlos A. Morillo, MD*,
Michael Garfinkle, BA ,
Salim Yusuf, MD, PhD* and
Stuart J. Connolly, MD*
* Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, Ontario, Canada
University of Toronto, Toronto, Ontario, Canada.
Manuscript received October 8, 2004;
revised manuscript received November 15, 2004,
accepted November 29, 2004.
* Reprint requests and correspondence: Dr. Jeff S. Healey, McMaster University-General Site, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada. (Email: healeyj{at}hhsc.ca).
OBJECTIVES: This study was designed to identify all randomized clinical trial data evaluating angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for the prevention of atrial fibrillation (AF), to estimate the magnitude of this effect and to identify patient subgroups most likely to benefit.
BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce morbidity and mortality in patients with heart failure, vascular disease, and hypertension. Several reports suggest that they may also prevent the development of AF.
METHODS: A systematic review of the literature was performed to identify all reports of the effect of ACEIs or ARBs on the development of AF. Eligible studies had to be randomized, controlled, parallel-design human trials of an ACEI or ARB that collected data on the development of AF.
RESULTS: A total of 11 studies, which included 56,308 patients, were identified: 4 in heart failure, 3 in hypertension, 2 in patients following cardioversion for AF, and 2 in patients following myocardial infarction. Overall, ACEIs and ARBs reduced the relative risk of AF by 28% (95% confidence interval [CI] 15% to 40%, p = 0.0002). Reduction in AF was similar between the two classes of drugs (ACEI: 28%, p = 0.01; ARB: 29%, p = 0.00002) and was greatest in patients with heart failure (relative risk reduction [RRR] = 44%, p = 0.007). Overall, there was no significant reduction in AF in patients with hypertension (RRR = 12%, p = 0.4), although one trial found a significant 29% reduction in patients with left ventricular (LV) hypertrophy. In patients following cardioversion, there appears to be a large effect (48% RRR), but the confidence limits are wide (95% CI 21% to 65%).
CONCLUSIONS: Both ACEIs and ARBs appear to be effective in the prevention of AF. This benefit appears to be limited to patients with systolic left ventricular dysfunction or LV hypertrophy. The use of these drugs following cardioversion appears promising but requires further study.
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Abbreviations and Acronyms
| | AF = atrial fibrillation | | ACEI = angiotensin-converting enzyme inhibitor | | ARB = angiotensin-II receptor blocker | | CI = confidence interval | | HF = heart failure | | LVEF = left ventricular ejection fraction | | MI = myocardial infarction | | RAAS = renin-angiotensin-aldosterone system | | RRR = relative risk reduction |
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H1879 - H1888.
[Abstract]
[Full Text]
[PDF]
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J. R. Ehrlich, S. H. Hohnloser, and S. Nattel
Role of angiotensin system and effects of its inhibition in atrial fibrillation: clinical and experimental evidence
Eur. Heart J.,
March 1, 2006;
27(5):
512 - 518.
[Abstract]
[Full Text]
[PDF]
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L. Mascitelli and F. Pezzetta
Anti-Inflammatory Action of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
J. Am. Coll. Cardiol.,
February 21, 2006;
47(4):
889 - 889.
[Full Text]
[PDF]
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J. S. Healey, C. A. Morillo, and S. J. Connolly
Reply
J. Am. Coll. Cardiol.,
February 21, 2006;
47(4):
890 - 891.
[Full Text]
[PDF]
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C. J. Boos and G. Y.H. Lip
Prevention of Atrial Fibrillation by Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers
J. Am. Coll. Cardiol.,
February 21, 2006;
47(4):
889 - 890.
[Full Text]
[PDF]
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V J Karthikeyan and G. Y H Lip
Review: angiotensin converting enzyme inhibitors and angiotensin receptor blockers prevent atrial fibrillation
Evid. Based Med.,
February 1, 2006;
11(1):
15 - 15.
[Full Text]
[PDF]
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C. J. Boos, R. A. Anderson, and G. Y.H. Lip
Is atrial fibrillation an inflammatory disorder?
Eur. Heart J.,
January 2, 2006;
27(2):
136 - 149.
[Abstract]
[Full Text]
[PDF]
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J. S. Kalus, C. I. Coleman, and C. M. White
The Impact of Suppressing the Renin-Angiotensin System on Atrial Fibrillation
J. Clin. Pharmacol.,
January 1, 2006;
46(1):
21 - 28.
[Abstract]
[Full Text]
[PDF]
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S. Nattel
Aldosterone antagonism and atrial fibrillation: time for clinical assessment?
Eur. Heart J.,
October 2, 2005;
26(20):
2079 - 2080.
[Full Text]
[PDF]
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