ACE INHIBITORS, STATINS, ARBS: DO THEY REALLY PREVENT ...
ACE INHIBITORS, STATINS, ARBS: DO THEY REALLY PREVENT ATRIAL FIBRILLATION?
A.B. Curtis
University of South Florida, Tampa, FL, USA
Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in the adult population. It is associated with significant morbidity and mortality. Its pathophysiology and electrophysiology are not completely understood, but insights gained from basic research have greatly increased our knowledge in this area in recent years. The renin-angiotensin-aldosterone system (RAAS) produces its effect via angiotensin II and aldosterone, resulting in elevated intra-atrial pressure, atrial stretch, and intra-atrial fibrosis. It is now thought that inflammation also plays a role in the development and progression of AF. Many treatment modalities have been developed over the years for the management of AF. While they are still considered the first line of treatment for suppression of AF, antiarrhythmics often lead to treatment failure, complications and undesired consequences. Pulmonary vein ablation is an invasive procedure which is not always curative. Recently, there have been a variety of studies reporting the potential antiarrhythmic effects of various nonantiarrhythmic agents. Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, HMG-CoA reductase inhibitors (statins), and even fish oil and aldosterone antagonists have been shown to have potential beneficial effects in preventing AF in retrospective and small prospective studies. This presentation will provide a comprehensive review of the findings reported thus far about the antiarrhythmic effects of agents which are not antiarrhythmic drugs themselves, but which have been found to offer promise in the prevention and treatment of AF.
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