The Effect of Renin-Angiotensin-System-Inhibitor (RASI) on the Recurrence of Atrial Fibrillation (AF) after Pulmonary Vein Isolation (PVI) in Patients with Normal Left Atrium (LA)

Background: Although many experimental data support the suppressive effect of RASIs on the occurrence of AF, recent clinical trials revealed no benefit of RASIs to prevent AF. However, if appropriate patients were selected, RASIs could work more effectively. In this study, we hypothesized that RASIs was effective in patients with normal LA. Methods: We retrospectively studied 178 consecutive patients (mean age=60±12 yrs, 76% males) with normal LA (LA<40 mm) who underwent successful PVI for AF. Multivariate analysis was performed to clarify the predictors of AF recurrence. The effect of RASI on AF recurrence was also assessed. Results: AF recurred in 40 patients (22.6%) during the follow-up period (mean 498±377 days). Multivariate Cox proportional analysis revealed that treatment with RASIs (HR 0.32, 95%CI 0.14–0.71, P=0.005), duration of AF (HR 1.08/year, 95%CI 1.00–1.15, P=0.04), history of hypertension (HR 3.05, 95%CI 1.29–7.24, P=0.01), and ejection fraction (HR 0.54/10%, 95%CI 0.34–0.87, P=0.01) were associated with AF recurrence in patients with normal LA. Conclusion: Several factors could be the predictors of AF recurrence. RASIs could suppress AF recurrence in patients with normal LA after PVI.