Angiotensin II-antagonist in paroxysmal atrial fibrillation (ANTIPAF) trial
Abstract
BACKGROUND: Unlike antiarrhythmic drugs, the safety and beneficial effects of angiotensin II receptor blockade (ARB) in patients with structural heart disease is well established. The clinical efficacy of ARBs to prevent atrial fibrillation (AF) so far only has been shown in patients with structural heart disease. Here, we report the primary outcome of the Angiotensin II-Antagonist in Paroxysmal Atrial Fibrillation (ANTIPAF) trial, which investigated the effect of olmesartan medoxomil compared with placebo on AF burden in patients with paroxysmal AF without structural heart disease. METHODS AND RESULTS: The ANTIPAF trial was a prospective, randomized, placebo-controlled, multicenter trial analyzing the AF burden (percentage of days with documented episodes of paroxysmal AF) during a 12-month follow-up as the primary study end point. Four hundred thirty patients with documented paroxysmal AF without structural heart disease were randomized to placebo or 40 mg olmesartan per day. Concomitant therapy with ARBs, angiotensin-converting enzyme inhibitors, and antiarrhythmic drugs was prohibited. Patients were followed using daily transtelephonic ECG (tele-ECG) recordings independent of symptoms. The intention-to-treat population of the trial encompassed 425 patients (placebo group, n=211; olmesartan group, n=214). A total of 87 818 tele-ECGs were analyzed in these patients during follow-up (placebo group, 44 888 ECGs; olmesartan group, 42 930 ECGs). Thus, a mean of 207 tele-ECGs were recorded per patient. The primary end point (AF burden) was not different between the 2 groups (P=0.770). Secondary outcome parameters, including quality of life, also were not different. In particular, time to first AF recurrence, time to persistent AF, and number of hospitalizations were not different between the 2 groups. The time to prescription of recovery medication (amiodarone) was the only parameter showing an intergroup difference, with earlier prescription of amiodarone in the placebo group (P=0.022). CONCLUSIONS: One year of ARB therapy per se does not reduce the number of AF episodes in patients with documented paroxysmal AF without structural heart disease. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00098137.
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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 [241]
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 [241]
ARB therapy did not reduce atrial fibrillation burden in patients with atrial fibrillation without structural heart disease.
“ARB therapy did not reduce the AF burden in patients with AF without structural heart disease.241”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [241]
Polyunsaturated fatty acids failed to show convincing benefit.
“Similarly, polyunsaturated fatty acids failed to show convincing benefit.241,[694][695][696][697][698]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [241]
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BackgroundJanuary, C. T., Wann, L. S., Alpert, J. S., Calkins, H. G., Cigarroa, J. E., Cleveland, J. C., CONTI, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.021 · Cited by 574 · see citing works
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“ARBs have not prevented recurrences of paroxysmal or persistent atrial fibrillation [CAndesartan in the Prevention of Relapsing Atrial Fibrillation (CAPRAF) [573], Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico-Atrial Fibrillation (GISSI-AF) [574], and ANgioTensin II Antagonist In Paroxysmal…”
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- Authors
- Goette, A., Schön, N., Kirchhof, P., Breithardt, G., Fetsch, T., Häusler, K. G., Klein, H. U., Steinbeck, G., Wegscheider, K., & Meinertz, T.
- Affiliations
- University Hospital Münster (DE)
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2012-02
- Volume
- 5
- Issue
- 1
- Pages
- 43-51
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2149897387
- Semantic Scholar
- 8bd7095a22f776dcc11d6318b6bf8f43f7fcc8f0
- Cited by
- 187
- References
- 34
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 12 · 2023: 6 · 2022: 9 · 2021: 10 · 2020: 9 · 2019: 8 · 2018: 8 · 2017: 11 · 2016: 17 · 2015: 16 · 2014: 23 · 2013: 26 · 2012: 11
- FWCI
- 13.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (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
- paroxysmal atrial fibrillation, angiotensin receptor blockers, olmesartan medoxomil, atrial fibrillation burden, atrial fibrillation recurrence, amiodarone, quality of life, structural heart disease, antiarrhythmic drugs, hospitalization, persistent atrial fibrillation, secondary prevention
- MeSH terms
- Atrial Fibrillation, Dose-Response Relationship, Drug, Double-Blind Method, Electrocardiography, Female, Follow-Up Studies, Germany, Humans, Imidazoles, Male, Middle Aged, Prospective Studies, Tachycardia, Paroxysmal, Tetrazoles, Time Factors, Incidence, Treatment Outcome, Angiotensin II Type 1 Receptor Blockers
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