Does treatment with ACE inhibitors prevent the long term recurrences of lone atrial fibrillation after cardioversion?

UNLABELLED: This study aimed to prove that angiotensin-converting enzyme inhibitor (ACEI) could improve sinus rhythm maintenance after conversion of atrial fibrillation (AF).

METHODS AND RESULTS: A study of 36 patients with lone AF who undertook electrical conversion was conducted. Group 1 included 20 patients treated exclusively with a class I C antiarrhythmic (Propafenona, 450 mg daily) and group 2 included 16 patients treated with antiarrhythmic plus ACEI after cardioversion. These two groups were comparable, with mean age 56.2+/-11.8 vs. 57.7+/-6.1 years (P 0.709), onset of AF 2.47+/-3.72 vs. 5.5+/-7.37 months (P 0.205) and echocardiografic parameters: left atrium diameter 45.1+/-5.8 vs. 45.0+/-6.1 mm (P 0.995); LVTDV 48.5+/-5.0 vs. 48.6+/-6.4 mm (P 0.998); LVTSV 35.1+/-5.0 vs. 36.0+/-7.0 mm (P 0.737) and EF 59.0+/-6.9% vs. 54.8+/-6.1% (P 0.135). The patients were followed up clinically and electrocardiographically 12 months after conversion. Kaplan-Meier analysis showed a higher probability of remaining in sinus rhythm one year after cardioversion for group 2 compared to group 1 (37.5% vs. 20%). The mean time interval for the appearance of recurrences was significantly higher in patients treated with ACEI and antiarrhythmics compared to the patients treated only with antiarrhythmics (7.06+/-1.02 vs. 4.50+/-0.93 months; Breslow test (generalized Wilcoxon) - 4.473, P 0.034).

CONCLUSION: The addition of ACEI to an antiarrhythmic decreases the rate of AF recurrences and facilitates the maintenance of sinus rhythm after cardioversion.