Prevention of atrial fibrillation by renin-angiotensin system inhibition

January 01, 0001

Prevention of atrial fibrillation by renin-angiotensin system inhibition

Individual studies examining the effects of RAS inhibition on AF prevention have reported controversial results. The authors from Germany, the US, Denmark and Norway reviewed published clinical trial data on the effects of renin-angiotensin system (RAS) inhibition for the prevention of atrial fibrillation (AF), aiming to define when RAS inhibition is most effective. All published randomized controlled trials reporting the effects of treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in the primary or secondary prevention of AF were included. A total of 23 randomized controlled trials with 87,048 patients were analyzed. In primary prevention, 6 trials in hypertension, 2 trials in myocardial infarction, and 3 trials in heart failure were included (some being post-hoc analyses of randomized controlled trials). In secondary prevention, 8 trials after cardioversion and 4 trials assessing the medical prevention of recurrence were included.

Overall, RAS inhibition significantly reduced the odds ratio for AF by 33%, but there was substantial heterogeneity among trials. In primary prevention, RAS inhibition was effective in patients with heart failure and those with hypertension and left ventricular hypertrophy but not in post-myocardial infarction patients overall. In secondary prevention, RAS inhibition was often administered in addition to antiarrhythmic drugs, including amiodarone, further reducing the odds for AF recurrence after cardioversion by 45% (significant) and in patients on medical therapy by 63% (significant).

The researchers concluded: "This analysis supports the concept of RAS inhibition as an emerging treatment for the primary and secondary prevention of AF but acknowledges the fact that some of the primary prevention trials were post-hoc analyses. Further areas of uncertainty include potential differences among specific RAS inhibitors and possible interactions or synergistic effects with antiarrhythmic drugs."

An interesting spin-off for ACE and ARB usage.

For the full abstract, click here.

J Am Coll Cardiol 55:2299-2307, 25 May 2010 © 2010 by the American College of Cardiology Foundation
Prevention of Atrial Fibrillation by Renin-Angiotensin System Inhibition: A Meta-Analysis. Markus P. Schneider, Tsushung A. Hua, Michael Bohm et al. Correspondence to Dr. Roland E. Schmieder: [email protected]

Category: K. Circulatory. Keywords: atrial fibrillation, angiotensin, angiotensin type 1 receptor, angiotensin converting enzyme inhibitors, renin-angiotensin system, meta analysis, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 25 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.