Prevention of Atrial Fibrillation by Renin-Angiotensin System Inhibition

Schneider, Markus P.; Hua, Tsushung A.; Böhm, Michael; Wachtell, Kristian; Kjeldsen, Sverre E.; Schmieder, Roland E.

doi:10.1016/j.jacc.2010.01.043

Cited by 417Atrial Fibrillation Management and OutcomesCardiac electrophysiology and arrhythmiasCardiac Arrhythmias and Treatments

Prevention of Atrial Fibrillation by Renin-Angiotensin System Inhibition

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Schneider, Markus P., Hua, Tsushung A., Böhm, Michael, Wachtell, Kristian, Kjeldsen, Sverre E., Schmieder, Roland E.·2010·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2010.01.043

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Abstract

Objectives The authors 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.Background Individual studies examining the effects of RAS inhibition on AF prevention have reported controversial results.Methods 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.Results 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 reduced the odds ratio for AF by 33% (p < 0.00001), 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% (p = 0.01) and in patients on medical therapy by 63% (p < 0.00001).Conclusions 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.

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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 [236]
Inhibition of the renin-angiotensin-aldosterone system can prevent structural remodelling and recurrent AF.
“Inhibition of the renin-angiotensin-aldosterone system can prevent structural remodelling and recurrent AF.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [236]
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 [236]
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 [236]

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REVIEW Inhibition of the Renin-Angiotensin System for Prevention of Atrial Fibrillation
Zografos, T. A., Katritsis, D. G., & Ph., D. (2016)
Inhibition of the Renin-Angiotensin System for Prevention of Atrial Fibrillation
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The Role Of Renin Angiotensin System In Atrial Fibrillation.
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Authors: Schneider, M. P., Hua, T. A., Böhm, M., Wachtell, K., Kjeldsen, S. E., & Schmieder, R. E.
Affiliations: Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
Saarland University (DE)
Rigshospitalet (DK)
University of Oslo (NO)
Corresponding author: Schmieder, Roland E.
ORCID: Schneider, Markus P.
Böhm, Michael
Wachtell, Kristian
Kjeldsen, Sverre E.
Schmieder, Roland E.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2010-05
Volume: 55
Issue: 21
Pages: 2299-2307
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2010.01.043
OpenAlex: W8133324
Cited by: 417
References: 60
Citations by year: 2026: 12 · 2025: 22 · 2024: 13 · 2023: 20 · 2022: 17 · 2021: 18 · 2020: 24 · 2019: 21 · 2018: 17 · 2017: 25 · 2016: 29 · 2015: 28 · 2014: 26 · 2013: 41 · 2012: 41
FWCI: 31.60
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 1172 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
Funders: Deutsche Forschungsgemeinschaft (KFO 196)
DFG
Bristol-Myers Squibb
Merck Sharp & Dohme
Novartis
Takeda
AstraZeneca
Boehringer Ingelheim
Roche
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 › Cardiac Arrhythmias and Treatments
Keywords: atrial fibrillation, renin-angiotensin system blockade, ACE inhibitors, angiotensin receptor blockers, atrial fibrillation prevention, primary prevention, secondary prevention, heart failure, hypertension, left ventricular hypertrophy, myocardial infarction, cardioversion, antiarrhythmic drugs, amiodarone, atrial fibrillation recurrence
MeSH terms: Angiotensin-Converting Enzyme Inhibitors, Animals, Anti-Arrhythmia Agents, Atrial Fibrillation, Electrocardiography, Female, Humans, Male, Primary Prevention, Prognosis, Renin-Angiotensin System, Severity of Illness Index, Survival Analysis, Randomized Controlled Trials as Topic, Treatment Outcome, Risk Assessment

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Prevention of Atrial Fibrillation by Renin-Angiotensin System Inhibition

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