Document Detail

Role of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and aldosterone antagonists in the prevention of atrial and ventricular arrhythmias.
MedLine Citation:
PMID:  19113795     Owner:  NLM     Status:  MEDLINE    
Atrial arrhythmias, ventricular arrhythmias, and sudden cardiac death (SCD) are significant health problems and an economic burden to society. The renin-angiotensin-aldosterone system (RAAS) may play a key role in the occurrence of structural and electrical remodeling, potentially explaining the development of atrial and ventricular arrhythmias. Angiotensin II has been shown to regulate cardiac cell proliferation and to modulate cardiac myocyte ion channels. Results of post hoc analyses from prospective clinical trials appear to show that angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are most effective in the prevention of new-onset atrial fibrillation in patients with heart failure. It is difficult to determine if these agents are useful in the prevention of new-onset atrial fibrillation after myocardial infarction, and available evidence suggests that the benefit of ACE inhibitors and ARBs for prevention of new-onset atrial fibrillation in patients with hypertension appears limited to those with left ventricular hypertrophy. Patients with structural changes in cardiac muscle, such as those with heart failure and left ventricular hypertrophy, appear to benefit the most from RAAS blockade, possibly due to the theory of reversal of cardiac remodeling. There is no evidence, to our knowledge, that either ACE inhibitors or ARBs facilitate direct electrical current cardioversion in patients with atrial fibrillation; however, it appears that RAAS blockade may be useful in the prevention of recurrent atrial fibrillation after direct electrical current cardioversion. Whether ACE inhibitors may prevent life-threatening ventricular arrhythmias or SCD is unclear. Aldosterone antagonists appear to be useful for the prevention of SCD in patients with left ventricular systolic dysfunction. Results from ongoing clinical trials are anticipated to provide further insight on the potential roles of RAAS inhibitors for the prevention of cardiac arrhythmias.
Kathy M Makkar; Cynthia A Sanoski; Sarah A Spinler
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Pharmacotherapy     Volume:  29     ISSN:  1875-9114     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-30     Completed Date:  2009-06-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  31-48     Citation Subset:  IM    
Department of Pharmacy, Lancaster General Hospital, Lancaster, Pennsylvania, USA.
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MeSH Terms
Aldosterone Antagonists / therapeutic use*
Angiotensin II Type 1 Receptor Blockers / therapeutic use*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Atrial Fibrillation / etiology,  prevention & control*
Clinical Trials as Topic
Death, Sudden, Cardiac / prevention & control
Heart Failure / complications
Hypertension / complications
Meta-Analysis as Topic
Renin-Angiotensin System / drug effects
Ventricular Dysfunction, Left / complications
Ventricular Fibrillation / etiology,  prevention & control*
Reg. No./Substance:
0/Aldosterone Antagonists; 0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors

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