Association of pretreatment with angiotensin-converting enzyme inhibitors with improvement in ablation outcome in atrial fibrillation patients with low left ventricular ejection fraction

Sanghamitra Mohanty, Prasant Mohanty, Chintan Trivedi, Carola Gianni, Rong Bai, John David Burkhardt, Joseph G. Gallinghouse, Rodney Horton, Javier E. Sanchez, Patrick M. Hranitzky, Amin Al-Ahmad, Shane Bailey, Luigi Di Biase, Andrea Natale

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Abstract

Background Angiotensin-converting enzyme inhibitors (ACEIs) reduce the incidence of atrial fibrillation (AF). Objective The purpose of this study was to assess the impact of upstream ACEI therapy on postablation AF recurrence and hospitalization in patients with low left ventricular ejection fraction (LVEF). Methods Three hundred forty-five consecutive patients undergoing first AF ablation with low LVEF (≤45%) were classified into group 1 (ACEI+, n = 187 [54%], of whom 44 patients [23.5%] had paroxysmal AF [PAF]) or group 2 (ACEI-, n = 158 [46%]; 31 of these 158 patients [19.6%] had PAF). Additionally, 703 consecutive patients with LVEF >45% undergoing first AF ablation were included for a secondary analysis to evaluate the effect of ACEI treatment in normal ejection fraction. In group 1, ACEI therapy started ≥3 months before ablation and continued through follow-up. Results Baseline characteristics were similar except for hypertension, which was significantly more prevalent in ACEI+ (71% vs 51%, P <001). At 24 ± 7 months of follow-up, 109 nonparoxysmal AF patients in group 1 (76%) and 81 (64%) in group 2 (P =.015) were recurrence free. In multivariate analysis, ACEI therapy was an independent predictor of recurrence (hazard ratio for ACEI-, 1.7, 95% confidence interval 1.1-2.7; P =.026]. However, among PAF patients, ACEI use was not associated with ablation success (80% vs 77% in ACEI+ and ACEI-, respectively; P =.82). In the normal-EF population, the success rates between ACEI+ and ACEI- cohorts were similar (71% vs 74%, P =.31). After the index procedure, 17 patients (9.1%) in the ACEI+ group and 28 (17.7%) in the ACEI- cohort (P=.02) required rehospitalization, for a 49% relative risk reduction (relative risk 0.51, 95% confidence interval 0.29-0.90). Conclusion Preablation use of an ACEI is associated with improvement in ablation outcome in patients with nonparoxysmal AF with low LVEF.

Original languageEnglish (US)
Pages (from-to)1963-1971
Number of pages9
JournalHeart Rhythm
Volume12
Issue number9
DOIs
StatePublished - Sep 1 2015

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Angiotensin-Converting Enzyme Inhibitors
Stroke Volume
Atrial Fibrillation
Enzyme Therapy
Recurrence
Confidence Intervals
Risk Reduction Behavior

Keywords

  • Ablation outcome
  • AF-related hospitalization
  • Angiotensin-converting enzyme inhibitors
  • Low left ventricular ejection fraction
  • Nonparoxysmal atrial fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Association of pretreatment with angiotensin-converting enzyme inhibitors with improvement in ablation outcome in atrial fibrillation patients with low left ventricular ejection fraction. / Mohanty, Sanghamitra; Mohanty, Prasant; Trivedi, Chintan; Gianni, Carola; Bai, Rong; Burkhardt, John David; Gallinghouse, Joseph G.; Horton, Rodney; Sanchez, Javier E.; Hranitzky, Patrick M.; Al-Ahmad, Amin; Bailey, Shane; Di Biase, Luigi; Natale, Andrea.

In: Heart Rhythm, Vol. 12, No. 9, 01.09.2015, p. 1963-1971.

Research output: Contribution to journalArticle

Mohanty, S, Mohanty, P, Trivedi, C, Gianni, C, Bai, R, Burkhardt, JD, Gallinghouse, JG, Horton, R, Sanchez, JE, Hranitzky, PM, Al-Ahmad, A, Bailey, S, Di Biase, L & Natale, A 2015, 'Association of pretreatment with angiotensin-converting enzyme inhibitors with improvement in ablation outcome in atrial fibrillation patients with low left ventricular ejection fraction', Heart Rhythm, vol. 12, no. 9, pp. 1963-1971. https://doi.org/10.1016/j.hrthm.2015.06.007
Mohanty, Sanghamitra ; Mohanty, Prasant ; Trivedi, Chintan ; Gianni, Carola ; Bai, Rong ; Burkhardt, John David ; Gallinghouse, Joseph G. ; Horton, Rodney ; Sanchez, Javier E. ; Hranitzky, Patrick M. ; Al-Ahmad, Amin ; Bailey, Shane ; Di Biase, Luigi ; Natale, Andrea. / Association of pretreatment with angiotensin-converting enzyme inhibitors with improvement in ablation outcome in atrial fibrillation patients with low left ventricular ejection fraction. In: Heart Rhythm. 2015 ; Vol. 12, No. 9. pp. 1963-1971.
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title = "Association of pretreatment with angiotensin-converting enzyme inhibitors with improvement in ablation outcome in atrial fibrillation patients with low left ventricular ejection fraction",
abstract = "Background Angiotensin-converting enzyme inhibitors (ACEIs) reduce the incidence of atrial fibrillation (AF). Objective The purpose of this study was to assess the impact of upstream ACEI therapy on postablation AF recurrence and hospitalization in patients with low left ventricular ejection fraction (LVEF). Methods Three hundred forty-five consecutive patients undergoing first AF ablation with low LVEF (≤45{\%}) were classified into group 1 (ACEI+, n = 187 [54{\%}], of whom 44 patients [23.5{\%}] had paroxysmal AF [PAF]) or group 2 (ACEI-, n = 158 [46{\%}]; 31 of these 158 patients [19.6{\%}] had PAF). Additionally, 703 consecutive patients with LVEF >45{\%} undergoing first AF ablation were included for a secondary analysis to evaluate the effect of ACEI treatment in normal ejection fraction. In group 1, ACEI therapy started ≥3 months before ablation and continued through follow-up. Results Baseline characteristics were similar except for hypertension, which was significantly more prevalent in ACEI+ (71{\%} vs 51{\%}, P <001). At 24 ± 7 months of follow-up, 109 nonparoxysmal AF patients in group 1 (76{\%}) and 81 (64{\%}) in group 2 (P =.015) were recurrence free. In multivariate analysis, ACEI therapy was an independent predictor of recurrence (hazard ratio for ACEI-, 1.7, 95{\%} confidence interval 1.1-2.7; P =.026]. However, among PAF patients, ACEI use was not associated with ablation success (80{\%} vs 77{\%} in ACEI+ and ACEI-, respectively; P =.82). In the normal-EF population, the success rates between ACEI+ and ACEI- cohorts were similar (71{\%} vs 74{\%}, P =.31). After the index procedure, 17 patients (9.1{\%}) in the ACEI+ group and 28 (17.7{\%}) in the ACEI- cohort (P=.02) required rehospitalization, for a 49{\%} relative risk reduction (relative risk 0.51, 95{\%} confidence interval 0.29-0.90). Conclusion Preablation use of an ACEI is associated with improvement in ablation outcome in patients with nonparoxysmal AF with low LVEF.",
keywords = "Ablation outcome, AF-related hospitalization, Angiotensin-converting enzyme inhibitors, Low left ventricular ejection fraction, Nonparoxysmal atrial fibrillation",
author = "Sanghamitra Mohanty and Prasant Mohanty and Chintan Trivedi and Carola Gianni and Rong Bai and Burkhardt, {John David} and Gallinghouse, {Joseph G.} and Rodney Horton and Sanchez, {Javier E.} and Hranitzky, {Patrick M.} and Amin Al-Ahmad and Shane Bailey and {Di Biase}, Luigi and Andrea Natale",
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T1 - Association of pretreatment with angiotensin-converting enzyme inhibitors with improvement in ablation outcome in atrial fibrillation patients with low left ventricular ejection fraction

AU - Mohanty, Sanghamitra

AU - Mohanty, Prasant

AU - Trivedi, Chintan

AU - Gianni, Carola

AU - Bai, Rong

AU - Burkhardt, John David

AU - Gallinghouse, Joseph G.

AU - Horton, Rodney

AU - Sanchez, Javier E.

AU - Hranitzky, Patrick M.

AU - Al-Ahmad, Amin

AU - Bailey, Shane

AU - Di Biase, Luigi

AU - Natale, Andrea

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background Angiotensin-converting enzyme inhibitors (ACEIs) reduce the incidence of atrial fibrillation (AF). Objective The purpose of this study was to assess the impact of upstream ACEI therapy on postablation AF recurrence and hospitalization in patients with low left ventricular ejection fraction (LVEF). Methods Three hundred forty-five consecutive patients undergoing first AF ablation with low LVEF (≤45%) were classified into group 1 (ACEI+, n = 187 [54%], of whom 44 patients [23.5%] had paroxysmal AF [PAF]) or group 2 (ACEI-, n = 158 [46%]; 31 of these 158 patients [19.6%] had PAF). Additionally, 703 consecutive patients with LVEF >45% undergoing first AF ablation were included for a secondary analysis to evaluate the effect of ACEI treatment in normal ejection fraction. In group 1, ACEI therapy started ≥3 months before ablation and continued through follow-up. Results Baseline characteristics were similar except for hypertension, which was significantly more prevalent in ACEI+ (71% vs 51%, P <001). At 24 ± 7 months of follow-up, 109 nonparoxysmal AF patients in group 1 (76%) and 81 (64%) in group 2 (P =.015) were recurrence free. In multivariate analysis, ACEI therapy was an independent predictor of recurrence (hazard ratio for ACEI-, 1.7, 95% confidence interval 1.1-2.7; P =.026]. However, among PAF patients, ACEI use was not associated with ablation success (80% vs 77% in ACEI+ and ACEI-, respectively; P =.82). In the normal-EF population, the success rates between ACEI+ and ACEI- cohorts were similar (71% vs 74%, P =.31). After the index procedure, 17 patients (9.1%) in the ACEI+ group and 28 (17.7%) in the ACEI- cohort (P=.02) required rehospitalization, for a 49% relative risk reduction (relative risk 0.51, 95% confidence interval 0.29-0.90). Conclusion Preablation use of an ACEI is associated with improvement in ablation outcome in patients with nonparoxysmal AF with low LVEF.

AB - Background Angiotensin-converting enzyme inhibitors (ACEIs) reduce the incidence of atrial fibrillation (AF). Objective The purpose of this study was to assess the impact of upstream ACEI therapy on postablation AF recurrence and hospitalization in patients with low left ventricular ejection fraction (LVEF). Methods Three hundred forty-five consecutive patients undergoing first AF ablation with low LVEF (≤45%) were classified into group 1 (ACEI+, n = 187 [54%], of whom 44 patients [23.5%] had paroxysmal AF [PAF]) or group 2 (ACEI-, n = 158 [46%]; 31 of these 158 patients [19.6%] had PAF). Additionally, 703 consecutive patients with LVEF >45% undergoing first AF ablation were included for a secondary analysis to evaluate the effect of ACEI treatment in normal ejection fraction. In group 1, ACEI therapy started ≥3 months before ablation and continued through follow-up. Results Baseline characteristics were similar except for hypertension, which was significantly more prevalent in ACEI+ (71% vs 51%, P <001). At 24 ± 7 months of follow-up, 109 nonparoxysmal AF patients in group 1 (76%) and 81 (64%) in group 2 (P =.015) were recurrence free. In multivariate analysis, ACEI therapy was an independent predictor of recurrence (hazard ratio for ACEI-, 1.7, 95% confidence interval 1.1-2.7; P =.026]. However, among PAF patients, ACEI use was not associated with ablation success (80% vs 77% in ACEI+ and ACEI-, respectively; P =.82). In the normal-EF population, the success rates between ACEI+ and ACEI- cohorts were similar (71% vs 74%, P =.31). After the index procedure, 17 patients (9.1%) in the ACEI+ group and 28 (17.7%) in the ACEI- cohort (P=.02) required rehospitalization, for a 49% relative risk reduction (relative risk 0.51, 95% confidence interval 0.29-0.90). Conclusion Preablation use of an ACEI is associated with improvement in ablation outcome in patients with nonparoxysmal AF with low LVEF.

KW - Ablation outcome

KW - AF-related hospitalization

KW - Angiotensin-converting enzyme inhibitors

KW - Low left ventricular ejection fraction

KW - Nonparoxysmal atrial fibrillation

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