The role of angiotensin receptor blockers and/or angiotensin converting enzyme inhibitors in the prevention of atrial fibrillation in patients with cardiovascular diseases: meta-analysis of randomized controlled clinical trials

The inhibition of the renin-angiotensin system has demonstrated both experimental and clinical effects in preventing atrial fibrillation. However, there is still uncertainty about the role of these drugs in clinical practice. The objective of this review has been to assess the effects of angiotensin II type-1 receptor blockers (ARBs) and/or angiotensin converting enzyme inhibitors (ACEIs) for preventing atrial fibrillation. We searched the Cochrane controlled Trials Register (Cochrane Library Issue 4, 2002), MEDLINE (January 1980 to November 2003), EMBASE (January 1980 to November 2003) and reference list of articles. We also contacted manufacturers and researchers in the field. Selection criteria: We conducted a meta-analysis of all randomized controlled clinical trials that compared ARBs and/or ACEIs with either placebo or conventional therapy in patients with either hypertension, heart failure, ischemic heart disease, or diabetes mellitus. The pooled outcome was the development of new onset atrial fibrillation. Two reviewers independently assessed trial quality and extracted data. In some cases, the study authors were contacted for additional information. Seven trials involving a total of 24,849 patients were included (11,328 randomized to active therapy and 13,521 to control). There was a significant statistical difference in the pooled development of atrial fibrillation between the treatment and control group. (OR, 0.57; 95% CI, 0.39 to 0.82); test for overall effect z = 2.98 P = 0.003). Treatment with ACEIs/ARBs markedly reduces the risk of development or recurrence of atrial fibrillation.