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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
ARTICLE HIGHLIGHTS
Research background
Cryo-balloon ablation (CBA) is recommended for patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drugs. However, only 80% of patients benefit from initial CBA.
Research motivation
Myocardial fibrosis is a known risk factor for the development of AF and angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are known agents that prevent remodeling. There is growing evidence that pretreatment with ACEIs and ARBs decreases the recurrence of AF postablation, particularly in nonparoxysmal AF undergoing radiofrequency ablation.
Research objectives
To investigate the role of ACEIs and ARBs in preventing the recurrence of atrial arrhythmia (AA) following CBA for paroxysmal AF.
Research methods
We performed a single-center, retrospective, cross-sectional study. All patients aged 18 years or older, with a diagnosis of paroxysmal AF, undergoing CBA as a first or repeat procedure between January 2015 and April 2018 were included. We followed these patients with paroxysmal AF undergoing CBA for 1 year post-procedure. Recurrence was assessed by documented AA on electrocardiogram or any form of long-term cardiac rhythm monitoring.
Research results
After 1-year follow-up, out of 103 patients, 19 (18.4%) developed recurrence of AA. Of these, 42 patients were receiving ACEIs/ARBs at the time of CBA. 21 (58%) patients were taking ACEIs and 15 (42%) ARBs. Patients on ACEIs/ARBs 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 the recurrence of AA following CBA (P = 0.72). Similarly, on Kaplan–Meier analysis pretreatment with ACEIs/ARBs did not predict the time to first recurrence of AA (P = 0.2173).
Research conclusions
In paroxysmal AF patients undergoing CBA, the use of ACEIs or ARBs was not associated with decreased recurrence of AA.
Research perspectives
Future studies, particularly in patients with persistent AF and those at risk for significant myocardial fibrosis such as cardiomyopathy, heart failure or valvular disease are necessary to fully evaluate the effect of ACEIs, ARBs, or angiotensin receptor neprilysin inhibitors such as sacubitril/valsartan in patients undergoing CBA for AF.
