The role of the renin-angiotensin system blocking in the management of atrial fibrillation

OBJECTIVE: The objective of the study was to review the current available clinical evidence for the role of renin-angiotensin system (RAS) blockade in the treatment of atrial fibrillation (AF). METHOD: We conducted a Pubmed and Medline literature search (January 1980 through May 2007) to identify all clinical trials published in English involving the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) for preventing the occurrence or recurrence of AF. Discussing pathophysiology and experimental evidence in detail is beyond the scope of this article. CONCLUSION: There is no solid evidence to support using ACE inhibitors or ARBs as antiarrhythmic therapy in patients with AF. However, in view of the possible benefits and the low incidence of side effects with ACE inhibitors and ARBs, they might be given in patients with recurrent AF, particularly if there are other indications for their use such as hypertension, HF, or diabetes mellitus. Possible benefits from pre-treatment argue in favour of using ACE inhibitors and ARB as first-line therapy in patients with hypertension.