Angiotensin receptor blockers or angiotensin converting enzyme inhibitors in the prevention of atrial fibrillation

Angiotensin converting enzyme inhibitors and angiotensin receptor blockers may be effective in the prevention of atrial fibrillation in patients with cardiovascular diseases.

A systematic review including 7 studies with a total of 24,849 subjects was abstracted in DARE. There was a significant difference in the development of atrial fibrillation (new-onset or recurrence post-cardioversion) in favour of treatment with ACEIs or ARBs compared with control (OR 0.57, 95% CI: 0.39 to 0.82). There was significant heterogeneity across the studies. A subgroup analysis of studies that included higher risk patients (those with left ventricular dysfunction or previous documented atrial fibrillation; n=7,250) showed that there was a significant benefit of treatment with ACEIs or ARBs compared with control (OR 0.42, 95% CI: 0.27 to 0.66).

Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies) and by indirectness (combining ACEIs and ARBs in the meta-analysis may not be appropriate).

Ədəbiyyat

1. Madrid AH, Peng J, Zamora J, Marín I, Bernal E, Escobar C, Muños-Tinoco C, Rebollo JM, Moro C. The role of angiotensin receptor blockers and/or angiotensin converting enzyme inhibitors in the prevention of atrial fibrillation in patients with cardiovascular diseases: meta-analysis of randomized controlled clinical trials. Pacing Clin Electrophysiol 2004 Oct;27(10):1405-10.