Valsartan for prevention of recurrent atrial fibrillation
Open accessAbstract
BACKGROUND: Atrial fibrillation is the most common cardiac arrhythmia, and no current therapy is ideal for control of this condition. Experimental studies suggest that angiotensin II-receptor blockers (ARBs) can influence atrial remodeling, and some clinical studies suggest that they may prevent atrial fibrillation. METHODS: We conducted a large, randomized, prospective, placebo-controlled, multicenter trial to test whether the ARB valsartan could reduce the recurrence of atrial fibrillation. We enrolled patients who were in sinus rhythm but had had either two or more documented episodes of atrial fibrillation in the previous 6 months or successful cardioversion for atrial fibrillation in the previous 2 weeks. To be eligible, patients also had to have underlying cardiovascular disease, diabetes, or left atrial enlargement. Patients were randomly assigned to receive valsartan or placebo. The two primary end points were the time to a first recurrence of atrial fibrillation and the proportion of patients who had more than one recurrence of atrial fibrillation over the course of 1 year. RESULTS: A total of 1442 patients were enrolled in the study. Atrial fibrillation recurred in 371 of the 722 patients (51.4%) in the valsartan group, as compared with 375 of 720 (52.1%) in the placebo group (adjusted hazard ratio, 0.97; 96% confidence interval [CI], 0.83 to 1.14; P=0.73). More than one episode of atrial fibrillation occurred in 194 of 722 patients (26.9%) in the valsartan group and in 201 of 720 (27.9%) in the placebo group (adjusted odds ratio, 0.89; 99% CI, 0.64 to 1.23; P=0.34). The results were similar in all predefined subgroups of patients, including those who were not receiving angiotensin-converting-enzyme inhibitors. CONCLUSIONS: Treatment with valsartan was not associated with a reduction in the incidence of recurrent atrial fibrillation. (ClinicalTrials.gov number, NCT00376272.)
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In patients with established AF, but without LV dysfunction or heart failure, ARBs do not prevent recurrent AF better than placebo.
“In patients with established AF, but without LV dysfunction or heart failure, ARBs do not prevent recurrent AF better than placebo.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [240]
The reduced incidence of AF with ACE inhibitors/ARBs is less evident in patients with HFpEF and is lost in patients without heart failure.
“The reduced incidence of AF with ACE inhibitors/ARBs is less evident in patients with HFpEF 239 and is lost in patients without heart failure.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [240]
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- Authors
- The GISSI-AF Investigators
- Affiliations
- Ospedale Santa Chiara (IT)
- Corresponding author
- The GISSI-AF Investigators
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2009-04-16
- Volume
- 360
- Issue
- 16
- Pages
- 1606-1617
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1492717268
- Cited by
- 441
- References
- 34
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 11 · 2023: 9 · 2022: 14 · 2021: 13 · 2020: 20 · 2019: 9 · 2018: 18 · 2017: 15 · 2016: 25 · 2015: 21 · 2014: 32 · 2013: 35 · 2012: 51
- FWCI
- 45.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion)
- Florence Research (University of Florence) (submittedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- 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
- valsartan, atrial fibrillation recurrence, angiotensin receptor blockers, atrial remodeling, cardioversion, left atrial enlargement, diabetes mellitus, cardiovascular disease
- MeSH terms
- Valsartan, Aged, Atrial Fibrillation, Cardiovascular Diseases, Diabetes Mellitus, Double-Blind Method, Female, Cardiomegaly, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Tetrazoles, Valine, Comorbidity, Proportional Hazards Models, Angiotensin II Type 1 Receptor Blockers
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