Renin-angiotensin system blocker use may be associated with suppression of atrial fibrillation recurrence after pulmonary vein isolation

Introduction: An additional approach may be essential to reduce recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI). We examined the efficacy of renin‐angiotensin system blockers (RAS‐B) in suppressing AF recurrences after PVI. Methods and Results: We retrospectively studied 264 consecutive patients (195 male, median age: 63 years) who underwent successful PVI of paroxysmal (n = 94) or persistent AF (n = 170). RAS‐B treatment was performed in 145 patients (angiotensin‐converting enzyme inhibitors; n = 13, angiotensin receptor blockers; n = 129, both; n = 3). Echocardiography was performed before and 3 months after the ablation to examine the occurrence of left atrial structural reverse remodeling (LA‐RR). After a median follow‐up of 195 (interquartile range: 95–316) days, AF recurred in 51 (19.3%) patients. A Cox regression analysis revealed that AF recurrence was significantly lower in the patients with RAS‐B than in those without (hazard ratio [HR] = 0.41 [95% confidence interval (CI): 0.23–0.71], P = 0.002). After a multivariate adjustment for potential confounders, the use of RAS‐B (HR = 0.39 [95% CI: 0.19–0.77], P = 0.007) and type of AF (HR = 0.30 [95% CI: 0.13–0.66], P = 0.003) were the independent predictors for AF recurrence during the entire follow‐up. Although effect of RAS‐B was not significant during the early follow‐up (<3 month), it was the only independent predictor during the late follow‐up (>3 months) (HR = 0.21 [95% CI: 0.08–0.53], P = 0.001). There were no significant differences in LA‐RR occurrence regarding RAS‐B medication. The use of RAS‐B was an independent predictor of late AF recurrences irrespective of an early LA‐RR occurrence. Conclusions: Treatment with RAS‐B significantly reduced the AF recurrence after PVI. This benefit became more prominent 3 months after the PVI. (PACE 2011; 34:296–303)