ACE inhibitors, sartans and atrial fibrillation

Atrial fibrillation is the most common susteined arrhythmia. It is associated with increased morbidity and mortality and decreased quality

of life. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers redukce morbidity and mortality in patients with

heart failure, vascular disease, and hypertension. The renin-angiotensin-aldosterone system (RAAS) is involved in the pathophysiology

of atrial fibrillation, and that RAAS blockade improves outcomes in atrial fibrillation merits plausibility. There are now mounting data to

suggest that modulation of the renin-angiotensin-aldosterone system might have an important role in the prevention of atrial fibrillation

and its consequences. The development and maintenance of atrial fibrillation is highly complex, and the renin-angiotensin-aldosterone

system may have a key role here. RAAS blockade should be part of the therapeutic management strategy for AF, especially in high risk

patient populations with hypertension, IHD, heart failure, diabetes mellitus or after myocardial infarction. There is a question, if RAAS

blockers should be given for lone AF without proved organic heart damane, or even as primary prevention of AF. So we have to wait for

results of clinical studies with more patients.

Keywords: atrial fibrillation, atrial remodelling, upstream therapy, angiotension-converting enzyme inhibitors, angiotensin receptor blockers.