Renin-Angiotensin Sy Stem Inhibitors Prevent The Recurrence Of Atrial Fibrillation:a Meta-Analysis Of Randomized Controlled Trials

OBJECTIVE:This study was designed to assess whether RAS inhibitors could prevent the recurrence of AF.METHODS:A systemic literature search of PubMed, EMBASE, and the Cochrane Controlled Trials Register from1950to November2012was performed to identify randomized controlled trials involving the prevention of atrial fibrillation recurrence with RAAS blockade therapy. Search terms included "angiotensin-converting enzyme inhibitors (ACEIs),angiotensin receptor blockers (ARBs)’ and individual ACEIs and ARBs agents combined with’atrial fibrillation, sinus rhythm". Randomized controlled trials (RCTs)of ACEIs or ARBs reporting AF recurrence were included. Data were extracted independently by two reviewers using a predefined data extraction sheet, including study quality indicators. Effect size was expressed as odds ratio (OR) with95%confidence interval (CI) and calculated with a random-effect model. Subgroup analysis and Meta-regression were performed to explore the reasons for heterogeneity. Publication bias was checked through funnel plot and Egger’s test.RESULTS:Twenty one RCTs including13184patients with AF were identified. Overall, the recurrence of AF was significantly reduced in patients using ACEI/ARBs (OR0.43.95%CI,0.32-0.56,p<0.00001), especially in irbesartan subgroup (OR0.38,95%CI,0.21-0.68,p=0.001) and in patients receiving antiarrhythmic drug (AAD)(OR,0.37;95%CI0.29-0.48,p<0.00001), and there was no significant difference between ACEIs and ARBs (ACEIs:OR0.42,95%CI,0.31-0.57; ARBs:OR,0.42.95%CI,0.31-0.57).In non-AAD subgroup the benefits of ACEI/ARBs revealed a positive correlation to SBP (regression coefficient:-0.0638415,p=0.000) in non-AAD users. A better efficacy was observed in participants younger than65years (OR,0.37;95%CI0.25-0.55) than those aged65(OR,0.48;95%Cl0.34-0.67) wherein percentage of male in trials revealed a positive-correlation to effect size (In(OR))of ACEI/ARBs(regression coefficient:4.895,p<0.01).CONCLUSIONS:ACEI/ARBs are effective on the secondary prevention of AF. especially in patients receiving AAD. Among patients without AAD. RAS inhibitors alone can still reduce the recurrence of AF and the higher the SBP, the more effective the RAS inhibitor in preventing AF recurrence.