Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on the Long-Term Outcome after Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

• Published in: Cardiology Vol. 117; no. 1; pp. 14 - 20
• Main Authors: Klemm, Hanno U., Heitzer, Thomas, Ruprecht, Ute, Meinertz, Thomas, Ventura, Rodolfo
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2010
• Subjects: Aged; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Atrial Fibrillation - surgery; Cardiac arrhythmia; Catheter Ablation - methods; Clinical outcomes; Combined Modality Therapy; Databases, Factual; Drug therapy; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Heart Conduction System - drug effects; Heart Conduction System - physiology; Humans; Long term; Male; Matched-Pair Analysis; Middle Aged; Original Research; Proportional Hazards Models; Pulmonary Veins - surgery; Risk Factors; Secondary Prevention; Treatment Outcome; Angiotensin-converting enzyme inhibitors; Atrial fibrillation; Catheter ablation; Angiotensin II receptor blockers; Pulmonary vein isolation
• ISSN: 0008-6312; 1421-9751
• DOI: 10.1159/000318016

Objectives: The effect of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARBs) on the long-term outcome after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) is unknown. Methods: This matched-pair study included 102 patients with PAF treated with ACE-I or ARBs (group 1) and 102 control subjects (group 2) after standardized PVI. Tele-ECG recorders were used to detect the end point of the first PAF recurrence after a 3-month blanking period. Results: Median follow-up was 2.1 years (range 0.3–6.3). In group 1, 51 (50%) patients suffered recurrences, with a mean time to recurrence of 3.2 years (95% CI 2.6–3.8). In group 2, 67 (65.7%) patients presented PAF after a mean period of 2.2 years (95% CI 1.7–2.8; p = 0.009). A second ablation was performed in 31 (50%) patients from the treatment group and in 48 (66.7%) patients from the control group (p = 0.02). Multivariate Cox analysis showed treatment with ACE-I and ARBs to be the only significant predictor of a reduced recurrence rate (HR 0.49, 95% CI 0.32–0.75). Conclusion: ACE-I and ARBs were effective for the preservation of sinus rhythm after PAF ablation, and they reduced the reablation rate.