The impact of suppressing the renin-angiotensin system on atrial fibrillation

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 atria] fibrillation, and prevention of atrial fibrillation recurrence after electrical cardioversion. A meta-analysis was performed Using a random-effects model. Use of an ongiotensin-converting enzyme (ACE) inhibitor or ongiotensin-receptor blocker (ARB) bias 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.