Prevention of atrial fibrillation by way of abrogation of the renin-angiotensin system: a systematic review and meta-analysis
Abstract
The renin-angiotensin-aldosterone system (RAAS) has emerged as an important hormonal system in the initiation and pathogenesis of atrial fibrillation (AF). Therefore, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are emerging as novel drugs for the prevention of AF. A meta-analysis of 11 randomized, controlled, parallel-design clinical trials evaluating effect of ACEIs or ARBs on the development of AF was performed. Treatment with ACEIs or ARBs reduced the relative risk (RR) of AF in patients with hypertension by 23% [RR 0.769, P < 0.001, 95% confidence interval (CI) 0.686-0.862] and by 11% in patients after myocardial infarction (RR 0.898, P < 0.05, 95% CI 0.814-0.992). Reduction in AF was greatest in patients after electrical cardioversion (RR 0.491, P < 0.001, 95% CI 0.334-0.720) and in patients with heart failure (RR 0.684, P < 0.001, 95% CI 0.594-0.787). Overall, inhibition of the RAAS reduced the RR of AF by 19% (RR 0.810, P < 0.001, 95% CI 0.759-0.865).
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Secondary analyses of ACE inhibitors or ARBs in patients with heart failure or LVH show a lower incidence of new-onset AF.
“Secondary analyses of ACE inhibitors or ARBs in patients with heart failure or LVH show a lower incidence of new-onset AF.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [238]
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 [238]
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- Authors
- Jibrini, M. B., Molnar, J., & Arora, R. R.
- Affiliations
- American College of Cardiology (US)
- ORCID
- Arora, Rohit R
- Venue
- American Journal of Therapeutics
- Published
- 2008-01
- Volume
- 15
- Issue
- 1
- Pages
- 36-43
- ISSN
- 1075-2765 (ISSN-L)
- OpenAlex
- W2159776801
- Cited by
- 111
- References
- 43
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2022: 1 · 2021: 5 · 2020: 2 · 2019: 4 · 2018: 5 · 2017: 2 · 2016: 10 · 2015: 5 · 2014: 11 · 2013: 8 · 2012: 7
- FWCI
- 2.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, renin-angiotensin-aldosterone system, ACE inhibitors, angiotensin receptor blockers, atrial fibrillation prevention, hypertension, myocardial infarction, electrical cardioversion, heart failure
- MeSH terms
- Angiotensin-Converting Enzyme Inhibitors, Atrial Fibrillation, Electric Countershock, Heart Failure, Humans, Hypertension, Myocardial Infarction, Renin-Angiotensin System, Risk Factors, Randomized Controlled Trials as Topic, Angiotensin II Type 1 Receptor Blockers
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