Role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in cryoballoon ablation outcomes for paroxysmal atrial fibrillation

Ibragim Al-Seykal; Abhishek Bose; Parag A Chevli; Zeba Hashmath; Nitish Sharma; Ajay K Mishra; Douglas Laidlaw

doi:10.4330/wjc.v14.i10.537

Role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in cryoballoon ablation outcomes for paroxysmal atrial fibrillation

World J Cardiol. 2022 Oct 26;14(10):537-545. doi: 10.4330/wjc.v14.i10.537.

Authors

Ibragim Al-Seykal¹, Abhishek Bose², Parag A Chevli³, Zeba Hashmath⁴, Nitish Sharma¹, Ajay K Mishra⁵, Douglas Laidlaw¹

Affiliations

¹ Department of Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States.
² Department of Medicine, Division of Cardiology, University of Massachusetts Chan School of Medicine, Worcester, MA 01608, United States.
³ Section on Hospital Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, United States.
⁴ Department of Medicine, Division of Cardiology, East Carolina University, Greenville, NC 27858, United States.
⁵ Department of Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States. ajay.mishra@stvincenthospital.com.

Abstract

Background: Cryoballoon ablation (CBA) is recommended for patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drugs. However, only 80% of patients benefit from initial CBA. There is growing evidence that pretreatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) decreases the recurrence of AF postablation, particularly in nonparoxysmal AF undergoing radiofrequency ablation. The role of ACEIs and ARBs in patients with paroxysmal AF in CBA remains unknown. We decided to investigate the role of ACEIs and ARBs in preventing the recurrence of atrial arrhythmia (AA) following CBA for paroxysmal AF.

Aim: To investigate the role of ACEIs and ARBs in preventing recurrence of AA following CBA for paroxysmal AF.

Methods: We followed 103 patients (age 60.6 ± 9.1 years, 29% women) with paroxysmal AF undergoing CBA 1-year post procedure. Recurrence was assessed by documented AA on electrocardiogram or any form of long-term cardiac rhythm monitoring. A multivariable Cox proportional hazard model was used to assess if ACEI or ARB treatment predicted the risk of AA recurrence.

Results: After a 1-year follow-up, 19 (18.4%) participants developed recurrence of AA. Use of ACEI or ARB therapy was noted in the study population. Patients on ACEI/ARB had a greater prevalence of hypertension and coronary artery disease. On a multivariate model adjusted for baseline demographics and risk factors for AF, ACEI or ARB therapy did not prevent recurrence of AA following CBA (P = 0.72). Similarly, on Kaplan-Meier analysis pretreatment with ACEI/ARB did not predict the time to first recurrence of AA (P = 0.2173).

Conclusion: In our study population, preablation treatment with an ACEI or ARB had no influence on the recurrence of AA following CBA for paroxysmal AF.

Keywords: Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; Cryoballoon ablation; Outcome; Paroxysmal atrial fibrillation.