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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Ibragim Al-Seykal, Nitish Sharma, Ajay K Mishra, Douglas Laidlaw, Department of Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
Abhishek Bose, Department of Medicine, Division of Cardiology, University of Massachusetts Chan School of Medicine, Worcester, MA 01608, United States
Parag A Chevli, Section on Hospital Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, United States
Zeba Hashmath, Department of Medicine, Division of Cardiology, East Carolina University, Greenville, NC 27858, United States
Author contributions: Al-Seykal I and Bose A contributed to the conceptual design of the study; Al-Seykal I, Bose A, Mishra A and Hashmath Z independently screened the medical records and extracted the data; Chevli P did the statistical analysis; Al-Seykal I, Mishra A, Hashmath Z and Sharma N contributed to write-up and submission of the study; Bose A, Mishra A, and Laidlaw D reviewed the final manuscript; all authors reviewed and agreed with the final content of the article.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of MetroWest Medical Center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ajay K Mishra, FACP, MBBS, MD, Academic Fellow, Assistant Professor, Department of Medicine, Division of Cardiology, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608, United States. ajay.mishra@stvincenthospital.com
Received: May 29, 2022
Peer-review started: May 29, 2022
First decision: June 8, 2022
Revised: June 18, 2022
Accepted: September 6, 2022
Article in press: September 6, 2022
Published online: October 26, 2022
Processing time: 144 Days and 0.2 Hours
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.
Core tip: We investigated the role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in preventing recurrence of atrial arrhythmias following cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (AF). Outcomes of 103 patients were evaluated in a retrospective chart review. Preablation treatment with an ACEI or ARB had no influence on recurrence of AA following CBA for paroxysmal AF. To our knowledge, this study is the first of its kind to examine the effect of ACEI/ARB use in this exclusive subset of patients.
