Introduction: Pulmonary
venous isolation has emerged as an effective method for preventing atrial
fibrillation (AF) recurrence. Yet, recurrence is common. Angiotensin-receptor-blockers (ARB`s) and angiotensin-converting-enzyme-inhibitors
(ACEI) are effective in reducing the extent of myocardial remodeling and
fibrosis. Our aim was to study whether pretreatment with ARB`s and ACEI was
effective in decreasing recurrence after pulmonary vein isolation for patients
with AF.
Methods: Three hundred and
twelve consecutive patients who underwent ablation from 12/2006 until 7/2010
were followed for at least one year. All patients underwent MRI before ablation
to assess atrial fibrosis. Data include demographic characteristics,
comorbidities, AF type and information regarding treatment with ACEI or ARB.
Results: Most patients were men (62%), mean age was 64. Hypertension (HTN) was present in 60%. Their
mean ejection fraction was 60%. There
were 104 patients (33.3%) treated with ACEI, and 13.5 % were treated with ARB
prior to ablation. Ninety seven patients (31.1%) had AF recurrence. AF type was a significant predictor for
recurrence (recurrence with paroxysmal, persistent and long-standing
persistent: 23.75, 37.3 and 60%, respectively, p=0.005). The most important factor predicting
recurrence was increased pre-ablation atrial fibrosis (p<0.0001). Recurrence
was more frequent in patients treated with ACEI (40.4% vs 26.4% untreated
patients, p=0.012). In the ARB treated group, 38.1% vs 30.0% untreated
experienced recurrence (p=0.3). After
multivariable adjustment for demographics, risk factors and fibrosis, treatment with ACEI was associated with
increased rate of recurrence in patients with persistent AF (hazard ratio: 2.6,
p=0.003). There was no significant
relation between ACEI pretreatment and recurrence in patients with paroxysmal
AF (HR- 0.83, p=0.7), or between ARB pre-treatment and recurrence in patients
with paroxysmal as well as persistent AF (p=0.2 and 0.53, respectively).
Conclusions: Pretreatment
with ACEI or ARB`s is not associated with reduced recurrence rate in patients
with paroxysmal or persistent AF undergoing ablation.
Credits: Boaz D Rosen; Nazem Akoum; Nathan Burgon; Gaston Vergara; Nassir Marrouche; Feras Bader