ACE Inhibitors and Angiotensin Receptor Blockers: a New Effective Non-Conventional Approach to Prevent Atrial Fibrillation

摘要

Atrial fibrillation is the most frequent arrhythmia found in clinical practice. Atrial fibrillation doubles mortality and increases the risk of stroke. The early appearance of electrical remodeling is followed by structural remodeling of the atrial tissue. In the past decade, arrhythmologists have been encouraged to investigate the etiology and pathophysiology of this type of frequent arrhythmia. These investigations have resulted in new concepts on the initiation and perpetuation of this arrhythmia. New techniques are being developed for its treatment. However, the majority of patients are candidates for the traditional treatment: antiarrhythmic drugs and/or electrical cardioversion. Direct current cardioversion of persistent atrial fibrillation is the most effective treatment for the restoration of sinus rhythm, but it may be hampered by a high percentage of recurrences. Many of the recurrences are probably the clinical consequence of electrical remodelling [1, 2], due to the changes in refractory period of atrial muscle and/or due to abnormal activity occurring inside the pulmonary veins. This could explain the drug-resistance of long-standing atrial fibrillation.