ORIGINAL ARTICLE

Pretreatment with ACE Inhibitors Improves Outcome of Electrical Cardioversion in Patients
With Presistent Atrial Fibrillation

Trudeke Van Noord1, Harry JGM Crijns2, Maarten P van den Berg1
Dirk J Van Veldhuisen1, Isabelle C Van Gelder1
1Department of Cardiology, Thoraxcenter, University Hospital Groningen,
Groningen, The Netherlands
2Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands

Abstract

Background: Persistent atrial fibrillation (AF) is difficult to treat. In the absence of class I or III antiarrhythmic drugs sinus rhythm is maintained in only 30% of patients during the first year after electrical cardioversion (ECV). One of the remodeling processes induced by AF is fibrosis, which relates to inducibility and maintenance of AF. The renin-angiotensin system may play a important role in this. The aim of this study was to investigate the role of angiotensin-converting enzyme (ACE) inhibitor use on efficacy of ECV, and occurrence of subacute recurrences.

Methods: One hundred-seven consecutive patients with persistent AF underwent ECV. In twenty-eight (26%) patients ACE inhibitors had been started before initiation of the present episode of AF ('pre-treated' patients).

Results: ECV was successful in 96% of patients who were on ACE inhibitors before start of the present episode of AF compared to 80% of the patients not pre-treated (p = 0.04). After 1 month of follow-up 49% of the pre-treated patients and 50% of those not pre-treated with ACE inhibition were still in sinus rhythm (p=ns). Multivariate analysis showed that pre-treatment with ACE inhibitors and a smaller left atrial size were independent predictors of successful ECV (OR = 5.8, C.I. 1.3–26.1, and OR = 5.6, C.I. 1.2–25.3, respectively).

Conclusions: Pre-treatment with ACE inhibitors may improve acute success of ECV but does not prevend AF recurrences. Heart Views 2005; 6 (1): 18-23.