(Circulation. 1999;100:376-380.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Trandolapril Reduces the Incidence of Atrial Fibrillation After Acute Myocardial Infarction in Patients With Left Ventricular Dysfunction
From the Department of Cardiology P, Gentofte University Hospital (O.D.P., L.K., C.T.-P.), and the Department of Medicine, Viborg Sygehus (H.B.), Denmark.
Correspondence to Ole Dyg Pedersen, MD, Department of Cardiology P, Gentofte University Hospital, Niels Andersensvej 65, 2900 Hellerup, Denmark. E-mail odplc{at}dadlnet.dk
Background—Studies have suggested that ACE inhibitors have an antiarrhythmic effect on ventricular arrhythmias. Whether they have an effect on atrial fibrillation is unknown.
Methods and Results—We investigated the effect of ACE inhibition with trandolapril on the incidence of atrial fibrillation in patients with reduced left ventricular function secondary to acute myocardial infarction. The patients in this study were those who qualified for inclusion into the TRAndolapril Cardiac Evaluation (TRACE) study, a randomized double-blind placebo-controlled study and who had sinus rhythm on the ECG obtained at randomization. Patients who fulfilled the criteria for inclusion were randomized to treatment with the ACE inhibitor trandolapril or placebo and were followed up for 2 to 4 years. Development and time to occurrence of atrial fibrillation in one 12-lead ECG recorded at the outpatient visits was the primary end point of this investigation. Of the 1749 patients included in the TRACE study, 1577 had sinus rhythm on the ECG recorded at randomization. Of these patients, 790 were randomized to trandolapril treatment and 787 to placebo treatment. The groups differed only slightly with respect to baseline characteristics. A total of 64 patients developed atrial fibrillation during the 2- to 4-year follow-up period. Significantly more patients developed atrial fibrillation in the placebo group than in the trandolapril group, 5.3% (n=42) versus 2.8% (n=22), respectively, P<0.05. Cox multivariable regression analysis, adjusting for important baseline characteristics, revealed that trandolapril treatment significantly reduced the risk of developing atrial fibrillation (RR, 0.45; 95% CI, 0.26 to 0.76; P<0.01).
Conclusions—The results from the present study demonstrate that trandolapril treatment reduces the incidence of atrial fibrillation in patients with left ventricular dysfunction after acute myocardial infarction.
Key Words: angiotensin • enzymes • fibrillation • myocardial infarction
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K. Kumagai, H. Nakashima, H. Urata, N. Gondo, K. Arakawa, and K. Saku Effects of angiotensin II type 1 receptor antagonist on electrical and structural remodeling in atrial fibrillation J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2197 - 2204. [Abstract] [Full Text] [PDF]
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H. U. Klein and A. Goette Blockade of atrial angiotensin II type 1 receptors: A novel antiarrhythmic strategy to prevent atrial fibrillation? J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2205 - 2206. [Full Text] [PDF]
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E. Vermes, J.-C. Tardif, M. G. Bourassa, N. Racine, S. Levesque, M. White, P. G. Guerra, and A. Ducharme Enalapril Decreases the Incidence of Atrial Fibrillation in Patients With Left Ventricular Dysfunction: Insight From the Studies Of Left Ventricular Dysfunction (SOLVD) Trials Circulation, June 17, 2003; 107(23): 2926 - 2931. [Abstract] [Full Text] [PDF]
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G. C. Gronefeld and S. H. Hohnloser Heart Failure Complicated by Atrial Fibrillation: Mechanistic, Prognostic, and Therapeutic Implications Journal of Cardiovascular Pharmacology and Therapeutics, June 1, 2003; 8(2): 107 - 113. [Abstract] [PDF]
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I. Savelieva and A. John Camm Atrial fibrillation and heart failure: natural history and pharmacological treatment Europace, January 1, 2003; 5(s1): S5 - S19. [Abstract] [Full Text] [PDF]
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P. Khairy and S. Nattel New insights into the mechanisms and management of atrial fibrillation Can. Med. Assoc. J., October 29, 2002; 167(9): 1012 - 1020. [Abstract] [Full Text] [PDF]
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A. H. Madrid, M. G. Bueno, J. M.G. Rebollo, I. Marin, G. Pena, E. Bernal, A. Rodriguez, L. Cano, J. M. Cano, P. Cabeza, et al. Use of Irbesartan to Maintain Sinus Rhythm in Patients With Long-Lasting Persistent Atrial Fibrillation: A Prospective and Randomized Study Circulation, July 16, 2002; 106(3): 331 - 336. [Abstract] [Full Text] [PDF]
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H. L. Kennedy and R. S. Rosenson Physicians' interpretation of "class effects": A need for thoughtful re-evaluation J. Am. Coll. Cardiol., July 3, 2002; 40(1): 19 - 26. [Abstract] [Full Text] [PDF]
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M. Allessie, J. Ausma, and U. Schotten Electrical, contractile and structural remodeling during atrial fibrillation Cardiovasc Res, May 1, 2002; 54(2): 230 - 246. [Abstract] [Full Text] [PDF]
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A. Goette, U. Lendeckel, and H. U Klein Signal transduction systems and atrial fibrillation Cardiovasc Res, May 1, 2002; 54(2): 247 - 258. [Abstract] [Full Text] [PDF]
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S. Nattel Therapeutic implications of atrial fibrillation mechanisms: can mechanistic insights be used to improve AF management? Cardiovasc Res, May 1, 2002; 54(2): 347 - 360. [Abstract] [Full Text] [PDF]
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A. Goette, G. Juenemann, B. Peters, H. U. Klein, A. Roessner, C. Huth, and C. Rocken Determinants and consequences of atrial fibrosis in patients undergoing open heart surgery Cardiovasc Res, May 1, 2002; 54(2): 390 - 396. [Abstract] [Full Text] [PDF]
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K. Shinagawa, H. Mitamura, S. Ogawa, and S. Nattel Effects of inhibiting Na+/H+-exchange or angiotensin converting enzyme on atrial tachycardia-induced remodeling Cardiovasc Res, May 1, 2002; 54(2): 438 - 446. [Abstract] [Full Text] [PDF]
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Y. Shi, D. Li, J.-C. Tardif, and S. Nattel Enalapril effects on atrial remodeling and atrial fibrillation in experimental congestive heart failure Cardiovasc Res, May 1, 2002; 54(2): 456 - 461. [Abstract] [Full Text] [PDF]
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J. McMurray and M. A. Pfeffer New Therapeutic Options in Congestive Heart Failure: Part I Circulation, April 30, 2002; 105(17): 2099 - 2106. [Full Text] [PDF]
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Members of the Sicilian Gambit New Approaches to Antiarrhythmic Therapy, Part I: Emerging Therapeutic Applications of the Cell Biology of Cardiac Arrhythmias Circulation, December 4, 2001; 104(23): 2865 - 2873. [Abstract] [Full Text] [PDF]
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Members of the Sicilian Gambit New approaches to antiarrhythmic therapy; emerging therapeutic applications of the cell biology of cardiac arrhythmias Eur. Heart J., December 1, 2001; 22(23): 2148 - 2163. [Abstract] [PDF]
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Members of the Sicilian Gambit New approaches to antiarrhythmic therapy: emerging therapeutic applications of the cell biology of cardiac arrhythmias Cardiovasc Res, December 1, 2001; 52(3): 345 - 360. [Abstract] [Full Text] [PDF]
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D. Li, K. Shinagawa, L. Pang, T. K. Leung, S. Cardin, Z. Wang, and S. Nattel Effects of Angiotensin-Converting Enzyme Inhibition on the Development of the Atrial Fibrillation Substrate in Dogs With Ventricular Tachypacing-Induced Congestive Heart Failure Circulation, November 20, 2001; 104(21): 2608 - 2614. [Abstract] [Full Text] [PDF]
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A.J. Camm Future role of electrical therapy for atrial fibrillation: reality for all? Eur. Heart J. Suppl., November 1, 2001; 3(suppl_P): P53 - P56. [Abstract] [PDF]
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Y. Shi, A. Ducharme, D. Li, R. Gaspo, S. Nattel, and J.-C. Tardif Remodeling of atrial dimensions and emptying function in canine models of atrial fibrillation Cardiovasc Res, November 1, 2001; 52(2): 217 - 225. [Abstract] [Full Text] [PDF]
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Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923. [PDF]
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