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The Impact of Suppressing the Renin-Angiotensin System on Atrial Fibrillation

From Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan (Dr Kalus); Henry Ford Hospital, Department of Pharmacy Services, Detroit, Michigan (Dr Kalus); University of Connecticut, School of Pharmacy, Storrs (Dr Coleman, Dr White); and Hartford Hospital, Department of Pharmacy, Hartford, Connecticut (Dr Coleman, Dr White).

Atrial fibrillation is very common in the United States. After a search of Medline, EMBASE, and CINAHL, 4 trials evaluating inhibitors of the renin-angiotensin system were identified for prevention of new-onset atrial fibrillation, facilitation of electrical cardioversion of atrial fibrillation, and prevention of atrial fibrillation recurrence after electrical cardioversion. A meta-analysis was performed using a random-effects model. Use of an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blocker (ARB) was associated with a reduction in new-onset atrial fibrillation (OR [95% CI] = 0.51 [0.36-0.72]), a lower failure rate of electrical cardioversion of atrial fibrillation (0.47 [0.24-0.92]), and a lower rate of recurrence of atrial fibrillation after electrical cardioversion (0.39 [0.20-0.75]). With the exception of the new-onset atrial fibrillation analysis, these findings were not associated with statistical heterogeneity. These hypothesis-generating data suggest that inhibitors of the renin-angiotensin system may provide benefit across the spectrum of atrial fibrillation.

Key Words: Atrial fibrillation • angiotensin-converting enzyme inhibitor • angiotensin receptor antagonist • systematic review

Address for reprints: James S. Kalus, PharmD, BCPS, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Suite 2190, Detroit, MI 48201.

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