Usefulness of upstream therapy with renin-angiotensin system inhibitors for prevention of new-onset atrial fibrillation in patients with heart failure

Background: The preventive effects of renin-angiotensin system inhibitors for suppression of newonset atrial fibrillation (AF) are unclear. In the present study, we evaluated the effect of angiotensin receptor blocker (ARB)/ angiotensin converting enzyme inhibitor (ACEI) on the incidence of newonset AF in patients with heart failure (HF). Methods: The study subject consisted of 525 patients with history of hospitalization due to HF without documented AF and they were all followed-up under standard pharmacological therapies for HF. The incidence and predicting factors for new-onset AF were evaluated by univariate and multivariate analyses. Results: During the observation period of 16 ± 10 months, 57 patients exhibited new onset AF. When compared with patients with and without new-onset AF in the univariate analysis, minimum level of serum brain natriuretic peptide (BNP) was higher, and incidence of use of ARB/ACEI was lower. In the multivariate analysis, higher minimum level of serum BNP, LVEF (left ventricular ejection fraction) <35% and no use of ARB/ACEI were the independent predicting factors for newonset AF. In Kaplan-Meier analysis, the incidence of AF was lower in patients with ARB/ACEI use than in patients without ARB/ACEI use (P = 0.0093). Conclusion: In patients with history of hospitalization due to HF, the use of ARB/ACEI was considered effective for prevention of new-onset AF.