Cardiovascular Drugs and Therapy

, Volume 26, Issue 1, pp 47–54

Systematic Review and Meta-Analysis: Renin-Angiotensin System Inhibitors in the Prevention of Atrial Fibrillation Recurrences. An Unfulfilled Hope

  • Marcello Disertori
  • Simona Barlera
  • Lidia Staszewsky
  • Roberto Latini
  • Silvia Quintarelli
  • Maria Grazia Franzosi
Review Article

DOI: 10.1007/s10557-011-6346-0

Cite this article as:
Disertori, M., Barlera, S., Staszewsky, L. et al. Cardiovasc Drugs Ther (2012) 26: 47. doi:10.1007/s10557-011-6346-0

Abstract

Purpose

To analyze the published data on the role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II-receptor blockers (ARBs) in secondary prevention of AF. Some post-hoc analyses from trials in different clinical scenarios suggested the efficacy of ACEIs and ARBs in the prevention of new onset atrial fibrillation (AF), while their efficacy in preventing AF recurrences is notably controversial.

Methods

The authors reviewed all published prospective, randomized vs. placebo or no-treatment studies, concerning the effect of ACEIs and ARBs in the prevention of AF recurrences. Four ACEIs studies accounting for a total of 355 patients and six ARBs studies comprising 4.040 patients were analyzed.

Results

The pooled ACEIs data showed a statistical significant effect in preventing AF recurrences. However, the studies did not have a robust follow-up algorithm to recognize AF episodes, and were individually very small. On the contrary, pooled ARBs data did not show any effect in preventing AF recurrences (RR 0.90; 95% CI, 0.75–1.08; p = 0.24). The ARBs analyzed population was much larger in three large prospective, randomized, double-blind, placebo-control trials with transtelephoning monitoring of AF recurrences and neutral results. The meta-analysis of ACEIs and ARBs trials together could suggest a publication bias that may result in an overestimation of the treatment effect.

Conclusions

Currently there is no role for ARBs in secondary prevention of AF. With regard to ACEIs, the data are not strong enough for a conclusion, although the efficacy is expected to be the same as that of ARBs.

Key words

Atrial fibrillation secondary prevention Angiotensin-converting enzyme inhibitors Angiotensin II-receptor blockers Atrial remodeling Upstream therapy 

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Marcello Disertori
    • 1
  • Simona Barlera
    • 2
  • Lidia Staszewsky
    • 2
  • Roberto Latini
    • 2
  • Silvia Quintarelli
    • 1
  • Maria Grazia Franzosi
    • 2
  1. 1.Department of CardiologySanta Chiara HospitalTrentoItaly
  2. 2.Department of Cardiovascular ResearchIstituto Mario NegriMilanItaly