| OBJECTIVES:This study was designed to identify all randomized controlled clinical trial data evaluating angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-II receptor blockers (ARBs) for the prevention of atrial fibrillation (AF), to assess and compare their effects in different patient populations.BACKGROUND:Current evidence suggests that ACEIs and ARBs have emerged as novel drugs in preventing the development of AF.METHODS:A MEDLINE, EMBASE, and Cochrane Controlled Trials Register (CCRT) search was carried out. Randomized controlled clinical trials reporting the prevention of AF by ACEIs or ARBs were identified. Data were extracted and meta-analysis was performed.RESULTS:A total of 26 studies were identified. Overall, ACEIs and ARBs revealed statistically significant preventive effects on AF [odds ratio (OR),0.65; 95% confidence interval (CI),0.55-0.76]. The prevention was similar between the two classes of drugs (ACEI:OR,0.68; ARB:OR,0.69). ACEIs and ARBs showed greater preventive effect on recurrent AF (OR,0.45; 95%CI,0.31-0.65) than on new-onset AF (OR,0.80; 95%CI,0.70-0.92). Prevention was greatest in patients with AF receiving amiodarone as a basic treatment drug (OR,0.35; 95%CI,0.26-0.48). In patients with heart failure, there appeared to be a large effect (OR,0.497), but the credible limits were wide (95%CrI,0.187-1.161).CONCLUSIONS:The prevention with ACEIs and ARBs appears to be more obvious on recurrent AF, especially in patients receiving amiodarone as a basic treatment drug. Otherwise, preventive effects may also be large in patients with heart failure, but the credible limits of its result are relatively wide, so more randomized controlled trials are necessary to further support this conclusion. The difference of effects between ACEI and ARB on prevention of AF is not statistically significant.
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