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J Am Coll Cardiol, 2006; 47:890-891, doi:10.1016/j.jacc.2005.11.034 (Published online 6 February 2006).
© 2006 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

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Jeff S. Healey, MD*, Carlos A. Morillo, MD and Stuart J. Connolly, MD, FACC

* Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, Ontario, Canada, L8L 2X2 (Email: healeyj{at}hhsc.ca).

Based on a growing body of evidence implicating inflammation in the development of atrial fibrillation (AF) (1–3), Drs. Mascitelli, Pezzetta, Boos, and Lip have postulated that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) may prevent AF by reducing inflammation. We agree that this is a plausible mechanism for AF prevention, particularly because a recent randomized-controlled trial has found that systemic corticosteroids reduce both C-reactive protein and the rate of recurrent AF in patients following cardioversion (2). However, none of the trials included in our meta-analysis (4) contained data on inflammatory markers; thus, we did not make this potential mechanism a focus of our discussion. Instead, we examined available trial data, such as the class of medication evaluated and the patient group studied, in an attempt to explain the significant heterogeneity in the results of individual trials (4).


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1. Chung MK, Martin DO, Sprecher D, et al. C-reactive protein elevation in patients with atrial arrhythmiasinflammatory mechanisms and persistence of atrial fibrillation. Circulation 1998;98:94-95.[Free Full Text]

2. Dernellis JM, Panaretou M. Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation Eur Heart J 2004;25:1100-1107.[Abstract/Free Full Text]

3. Van Wagoner DR. Basic mechanisms of atrial fibrillation Cleve Clin J Med 2003;70:S2-S5.[Abstract/Free Full Text]

4. Healey JS, Baranchuk A, Crystal E, et al. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockersa meta-analysis. J Am Coll Cardiol 2005;45:1832-1839.[Abstract/Free Full Text]


Related Article

Anti-Inflammatory Action of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
Luca Mascitelli and Francesca Pezzetta
J. Am. Coll. Cardiol. 2006 47: 889. [Full Text] [PDF]




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