The effects of statins and renin-angiotensin system blockers on atrial fibrillation recurrence following antral pulmonary vein isolation

Effect of Statins and RAS Blockers on AF Ablation. Introduction: Ablation has emerged as a major treatment option for atrial fibrillation (AF). However, this procedure is limited by a significant rate of AF recurrence. We aimed to examine the effects of statins, angiotensin-converting enzyme inhibitors (ACE-I), and angiotensin receptor blockers (ARB) on the recurrence rate of AF following ablation. Methods: We conducted a retrospective study of 177 consecutive patients (mean age = 56 +/- 11 yrs, 69% males) who underwent ablation for paroxysmal (n = 132) or persistent AF (n = 45). Patients were treated with ACE-I (n = 31) or ARB (n = 18) or statins (n = 50) prior to ablation and for the duration of follow-up. Results: After a mean follow-up of 13.8 +/- 8.6 months, 72% of patients were free of AF. For patients taking statins, 33 of 50 (60%) were free of AF. In patients treated with ACE-I, 17 of 31 (55%) were free from AF, while in the group of patients treated with ARB, 17 of 18 (94%) were free from AF. Using Cox regression analysis to correct for baseline variables, treatment with statins did not decrease the recurrence rate (HR = 1.10 [95% CI: 0.55-2.27] p = 0.79); nor did treatment with renin angiotensin system (RAS) blockers (HR 0.94 [95% CI: 0.46-1.93] p = 0.87). However, subgroup analysis showed that treatment with ARB was associated with a trend towards lower AF recurrence [HR 0.17, (95% CI: 0.02-1.34) p = 0.09]. Conclusions: Even though statins and RAS blockers possess anti-inflammatory properties, they did not decrease the recurrence of AF following ablation. However, the subset of patients taking ARB exhibited a trend towards lower AF recurrence. Larger, randomized studies are needed to address this observation.