CORRESPONDENCE: LETTERS TO THE EDITOR
Reduced atrial fibrillation incidence by angiotensin-converting enzyme inhibitors: A possible contributing mechanism
Malek El Muayed, MD*
* Department of Internal Medicine, MSB 1.150, The University of Texas–Houston, 6431 Fannin Street, Houston, Texas 77030 (Email: malek.el.muayed{at}uth.tmc.edu).
With great interest we read the study by L'Allier et al. (1) regarding a reduced incidence of atrial fibrillation in hypertensive subjects treated with angiotensin-converting enzyme (ACE) inhibition. The investigators mention several possible mechanisms contributing toward this effect. We and several other groups have shown that angiotensin I and II facilitate the release of norepinephrine from atrial sympathetic fibers through activation of prejunctional angiotensin receptors in human and animal models (2–4). This effect is reduced under the influence of angiotensin receptor antagonists and ACE inhibitors (5,6). An increase in sympathetic tone is considered by many researchers as an important factor in initiating and maintaining atrial fibrillation (7,8). In our view, the facilitative effect of angiotensins on norepinephrine release and the inhibition of this effect by ACE inhibitors and angiotensin receptor antagonists should be considered as possible mechanisms for the reduced occurrence of atrial fibrillation in ACE-inhibitor–treated patients.
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1. L'Allier PL, Ducharme A, Keller PF, Yu H, Guertin MC, Tardif JC. Angiotensin-converting enzyme inhibition in hypertensive patients is associated with a reduction in the occurrence of atrial fibrillation J Am Coll Cardiol 2004;44:159-164.[Abstract/Free Full Text]
2. Brasch H, Sieroslawski L, Dominiak P. Angiotensin II increases norepinephrine release from atria by acting on angiotensin subtype 1 receptors Hypertension 1993;22:699-704.[Abstract/Free Full Text]
3. Trendelenburg A, Meyer A, Klebroff W, Guimaraes S, Starke K. Crosstalk between presynaptic angiotensin receptors, bradykinin receptors and alpha(2)-autoreceptors in sympathetic neurons: a study in alpha(2)-adrenoceptor-deficient mice Br J Pharmacol 2003;138:1389-1402.[CrossRef][Web of Science][Medline]
4. Shetty S, DelGrande D. Differential inhibition of the prejunctional actions of angiotensin II in rat atria by valsartan, irbesartan, eprosartan, and losartan J Pharmacol Exp Ther 2000;294:179-186.[Abstract/Free Full Text]
5. El Muayed M, Stegbauer J, Oberhauser V, Vonend O, Rump L. AT1- and AT2-receptor antagonists inhibit Ang II-mediated facilitation of noradrenaline release in human atria J Cardiovasc Pharmacol 2004;43:318-324.[CrossRef][Web of Science][Medline]
6. Dendorfer A, Thornagel A, Raasch W, Grisk O, Tempel K, Dominiak P. Angiotensin II induces catecholamine release by direct ganglionic excitation Hypertension 2002;40:348-354.[Abstract/Free Full Text]
7. Joyachandran J, Sih H, Winkle W, Zipes D, Hutchins G, Olgin J. Atrial fibrillation produced by prolonged rapid atrial pacing is associated with heterogeneous changes in atrial sympathetic innervation Circulation 2000;101:1185-1191.[Abstract/Free Full Text]
8. Coumel P. Autonomic influence in atrial tachyarrhythmias J Cardiovasc Electrophysiol 1996;7:999-1007.[Web of Science][Medline]
Related Article
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Reduced atrial fibrillation incidence by angiotensin-converting enzyme inhibitors: A possible contributing mechanism: Reply
- Jean-Claude Tardif, Philippe L. L'Allier, Pierre-Frédéric Keller, and Anique Ducharme
J. Am. Coll. Cardiol. 2005 45: 1144.
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