The Role Of Renin Angiotensin System In Atrial Fibrillation.
The Role Of Renin Angiotensin System In Atrial Fibrillation.
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DOI：
10.4022/jafib.972
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发表时间：
2014-04-01
影响因子：
--
通讯作者：
Birnie, David H
中科院分区：
文献类型：
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作者：
Nair, Girish M;Nery, Pablo B;Birnie, David H
心房颤动（AF）是最常见的心律失常，其发病率呈上升趋势。AF引起显著的发病率和死亡率，导致AF相关的医疗保健成本上升。已有动物和人体研究的实验和临床证据表明，肾素血管紧张素系统（RAS）在AF的发病机制中发挥作用。本文综述了目前使用血管紧张素转换酶抑制剂（ACE-I）、血管紧张素受体阻滞剂（ARB）和醛固酮拮抗剂（AA）拮抗RAS的研究进展，RAS拮抗作用已被证明对心力衰竭和左心室（LV）功能障碍受试者的AF的一级和二级预防有效。然而，RAS拮抗作用保护作用的大多数证据来自以AF为次要结局的临床试验或未具体说明的事后分析。在无心力衰竭和LV功能正常的受试者中进行预防的证据尚不清楚。在没有伴随抗心律失常治疗的情况下，RAS拮抗作用未显示出减少心脏复律后AF复发。接受导管消融术的受试者的RAS拮抗作用在预防AF复发方面也无效。
Atrial fibrillation (AF) is the most prevalent arrhythmia and its incidence is on the rise. AF causes significant morbidity and mortality leading to rising AF-related health care costs. There is experimental and clinical evidence from animal and human studies that suggests a role for the renin angiotensin system (RAS) in the etiopathogenesis of AF. This review appraises the current understanding of RAS antagonism, using angiotensin converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB) and aldosterone antagonists (AA), for prevention of AF. RAS antagonism has proven to be effective for primary and secondary prevention of AF in subjects with heart failure and left ventricular (LV) dysfunction.However, most of the evidence for the protective effect of RAS antagonism is from clinical trials that had AF as a secondary outcome or from unspecified post-hoc analyses. The evidence for prevention in subjects without heart failure and with normal LV function is not as clear. RAS antagonism, in the absence of concomitant antiarrhythmic therapy, was not shown to reduce post cardioversion AF recurrences. RAS antagonism in subjects undergoing catheter ablation has also been ineffective in preventing AF recurrences.