Published online Oct 26, 2022. doi: 10.4330/wjc.v14.i10.537
Peer-review started: May 29, 2022
First decision: June 8, 2022
Revised: June 18, 2022
Accepted: September 6, 2022
Article in press: September 6, 2022
Published online: October 26, 2022
Processing time: 144 Days and 0.2 Hours
Cryo-balloon ablation (CBA) is recommended for patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drugs. However, only 80% of patients benefit from initial CBA.
Myocardial fibrosis is a known risk factor for the development of AF and angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are known agents that prevent remodeling. There is growing evidence that pretreatment with ACEIs and ARBs decreases the recurrence of AF postablation, particularly in nonparoxysmal AF undergoing radiofrequency ablation.
To investigate the role of ACEIs and ARBs in preventing the recurrence of atrial arrhythmia (AA) following CBA for paroxysmal AF.
We performed a single-center, retrospective, cross-sectional study. All patients aged 18 years or older, with a diagnosis of paroxysmal AF, undergoing CBA as a first or repeat procedure between January 2015 and April 2018 were included. We followed these patients with paroxysmal AF undergoing CBA for 1 year post-procedure. Recurrence was assessed by documented AA on electrocardiogram or any form of long-term cardiac rhythm monitoring.
After 1-year follow-up, out of 103 patients, 19 (18.4%) developed recurrence of AA. Of these, 42 patients were receiving ACEIs/ARBs at the time of CBA. 21 (58%) patients were taking ACEIs and 15 (42%) ARBs. Patients on ACEIs/ARBs had a greater prevalence of hypertension and coronary artery disease. On a multivariate model adjusted for baseline demographics and risk factors for AF, ACEI or ARB therapy did not prevent the recurrence of AA following CBA (P = 0.72). Similarly, on Kaplan–Meier analysis pretreatment with ACEIs/ARBs did not predict the time to first recurrence of AA (P = 0.2173).
In paroxysmal AF patients undergoing CBA, the use of ACEIs or ARBs was not associated with decreased recurrence of AA.
Future studies, particularly in patients with persistent AF and those at risk for significant myocardial fibrosis such as cardiomyopathy, heart failure or valvular disease are necessary to fully evaluate the effect of ACEIs, ARBs, or angiotensin receptor neprilysin inhibitors such as sacubitril/valsartan in patients undergoing CBA for AF.