Prevention of Atrial Fibrillation With Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
Open accessAbstract
Objectives This study was designed to identify all randomized clinical trial data evaluating angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for the prevention of atrial fibrillation (AF), to estimate the magnitude of this effect and to identify patient subgroups most likely to benefit.Background Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce morbidity and mortality in patients with heart failure, vascular disease, and hypertension. Several reports suggest that they may also prevent the development of AF.Methods A systematic review of the literature was performed to identify all reports of the effect of ACEIs or ARBs on the development of AF. Eligible studies had to be randomized, controlled, parallel-design human trials of an ACEI or ARB that collected data on the development of AF.Results A total of 11 studies, which included 56,308 patients, were identified: 4 in heart failure, 3 in hypertension, 2 in patients following cardioversion for AF, and 2 in patients following myocardial infarction. Overall, ACEIs and ARBs reduced the relative risk of AF by 28% (95% confidence interval [CI] 15% to 40%, p = 0.0002). Reduction in AF was similar between the two classes of drugs (ACEI: 28%, p = 0.01; ARB: 29%, p = 0.00002) and was greatest in patients with heart failure (relative risk reduction [RRR] = 44%, p = 0.007). Overall, there was no significant reduction in AF in patients with hypertension (RRR = 12%, p = 0.4), although one trial found a significant 29% reduction in patients with left ventricular (LV) hypertrophy. In patients following cardioversion, there appears to be a large effect (48% RRR), but the confidence limits are wide (95% CI 21% to 65%).Conclusions Both ACEIs and ARBs appear to be effective in the prevention of AF. This benefit appears to be limited to patients with systolic left ventricular dysfunction or LV hypertrophy. The use of these drugs following cardioversion appears promising but requires further study.
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Retrospective analyses from large randomized trials have reported a lower incidence of new-onset AF in patients treated with ACE inhibitors/ARBs compared with placebo.
“Retrospective analyses from large randomized trials have reported a lower incidence of new-onset AF in patients treated with ACE inhibitors/ARBs compared with placebo.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [237]
ACE inhibitors or ARBs appear to prevent new-onset atrial fibrillation in patients with left ventricular dysfunction.
“ACE inhibitors or ARBs appear to prevent new-onset AF in patients with LV dysfunction and in hypertensive patients with LV hypertrophy.219,236,237,239,246,250,686”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [237]
ACE inhibitors or ARBs appear to prevent new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy.
“ACE inhibitors or ARBs appear to prevent new-onset AF in patients with LV dysfunction and in hypertensive patients with LV hypertrophy.219,236,237,239,246,250,686”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [237]
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Self-citation
- Authors
- Healey, J. S., Baranchuk, A., Crystal, E., Morillo, C. A., Garfinkle, M., Yusuf, S., & Connolly, S. J.
- Affiliations
- Population Health Research Institute (CA)
- University of Toronto (CA)
- Corresponding author
- Healey, Jeff S.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2005-06
- Volume
- 45
- Issue
- 11
- Pages
- 1832-1839
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2111995867
- Cited by
- 822
- References
- 49
- Citations by year
- 2026: 12 · 2025: 17 · 2024: 21 · 2023: 23 · 2022: 17 · 2021: 16 · 2020: 20 · 2019: 19 · 2018: 27 · 2017: 29 · 2016: 25 · 2015: 26 · 2014: 39 · 2013: 45 · 2012: 51
- FWCI
- 12.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- atrial fibrillation, ACE inhibitors, angiotensin receptor blockers, atrial fibrillation prevention, heart failure, hypertension, left ventricular hypertrophy, left ventricular dysfunction, cardioversion, myocardial infarction
- MeSH terms
- Angiotensin-Converting Enzyme Inhibitors, Atrial Fibrillation, Electric Countershock, Humans, Comorbidity, Randomized Controlled Trials as Topic, Hypertrophy, Left Ventricular, Ventricular Dysfunction, Left, Angiotensin Receptor Antagonists
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