Impact of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on the long-term outcome after pulmonary vein isolation for paroxysmal atrial fibrillation

TY - JOUR

T1 - Impact of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on the long-term outcome after pulmonary vein isolation for paroxysmal atrial fibrillation

AU - Klemm, Hanno U

AU - Heitzer, Thomas

AU - Ruprecht, Ute

AU - Meinertz, Thomas

AU - Ventura, Rodolfo

N1 - Copyright © 2010 S. Karger AG, Basel.

PY - 2010

Y1 - 2010

N2 - 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.

AB - 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.

KW - Aged

KW - Angiotensin II Type 1 Receptor Blockers/therapeutic use

KW - Angiotensin-Converting Enzyme Inhibitors/therapeutic use

KW - Atrial Fibrillation/drug therapy

KW - Catheter Ablation/methods

KW - Combined Modality Therapy

KW - Databases, Factual

KW - Electrocardiography, Ambulatory

KW - Female

KW - Follow-Up Studies

KW - Heart Conduction System/drug effects

KW - Humans

KW - Male

KW - Matched-Pair Analysis

KW - Middle Aged

KW - Proportional Hazards Models

KW - Pulmonary Veins/surgery

KW - Risk Factors

KW - Secondary Prevention

KW - Treatment Outcome

U2 - 10.1159/000318016

DO - 10.1159/000318016

M3 - SCORING: Journal article

C2 - 20881389

VL - 117

SP - 14

EP - 20

JO - CARDIOLOGY

JF - CARDIOLOGY

SN - 0008-6312

IS - 1

ER -