Prognostic Impact of Angiotensin Converting Enzyme Inhibitors and Receptor Blockers on Recurrent Ventricular Tachyarrhythmias and ICD Therapies.

This study sought to assess the prognostic impact of treatment with angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) on recurrences of ventricular tachyarrhythmias in recipients of implantable cardioverter defibrillators (ICD).Using a large retrospective registry including consecutive ICD recipients with documented episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2016, those patients treated with ACEi/ARB were compared to patients without (non-ACEi/ARB). The primary prognostic endpoint was first recurrences of ventricular tachyarrhythmias and related ICD therapies at 5 years. Multivariable Cox regression analyses were applied within the entire cohort, and thereafter Kaplan-Meier analyses were performed in propensity-matched subgroups.A total of 592 consecutive ICD recipients were included (81% treated with ACEiARB and 19% without). Although ACEi/ARB was associated with no differences of overall recurrence of ventricular tachyarrhythmias, ACEi/ARB was especially associated with improved freedom from appropriate ICD therapy within multivariable Cox regressions (HR=0.666; p=0.043), especially in patients with index episodes of VF, LVEF <35%, coronary artery disease, secondary preventive ICDs and GFR <45 ml/min/1.73m.In the propensity-matched sub-group, ACEi/ARB still prolonged freedom from appropriate ICD therapies (HR=0.380; 95% CI 0.193-0.747; p=0.005).In conclusion, ACEi/ARB therapy was associated with improved freedom from appropriate ICD therapies.