Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM

Katherine T. Murray, Jeffrey N. Rottman, Patrick G. Arbogast, Lynn Shemanski, R. Kirby Primm, W. Barton Campbell, Allen J. Solomon, Jeffrey E. Olgin, Michael J. Wilson, John P. DiMarco, Karen J. Beckman, George Dennish, Gerald Naccarelli, Wayne A. Ray

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Abstract

Objectives: We investigated whether inhibition of endogenous angiotensin II signaling reduces the recurrence rate of atrial fibrillation (AF) in patients enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Background: Structural and electrical remodeling contribute to AF. Previous experimental studies have implicated the angiotensin II signaling pathway in this process, and recent clinical evidence supports a beneficial effect of inhibiting angiotensin II activity. Methods: Using the AFFIRM database, we retrospectively identified a cohort of patients randomized to the rhythm-control arm who were in sinus rhythm. Exposure to angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors (ANGI) was determined, and the time to first recurrence of AF was compared between ANGI users and nonusers. Results: The study cohort included 732 patients not taking ANGI through the initial 2-month follow-up and 421 patients taking ANGI during this time. Patients in the ANGI group more likely had hypertension, diabetes, coronary artery disease, and congestive heart failure compared to patients not taking ANGI. Risk of AF recurrence in the ANGI treatment group did not differ from the risk observed in patients not taking the drugs (hazard ratio [HR] = 0.91, 95% confidence interval [CI] = 0.77-1.09). However, in patients with congestive heart failure or impaired left ventricular function, ANGI use was associated with a lower risk of AF recurrence. Conclusions: This analysis provides evidence that ANGI use may be beneficial in some patient subgroups with AF and underscores the need for randomized clinical trials defining more fully the role of angiotensin II inhibition in treating AF.

Original languageEnglish (US)
Pages (from-to)669-675
Number of pages7
JournalHeart Rhythm
Volume1
Issue number6
DOIs
StatePublished - Dec 1 2004

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Angiotensin-Converting Enzyme Inhibitors
Angiotensin II
Atrial Fibrillation
Recurrence
Heart Failure
Atrial Remodeling
Angiotensin Receptor Antagonists
Left Ventricular Function
Coronary Artery Disease
Cohort Studies
Randomized Controlled Trials
Databases
Confidence Intervals
Hypertension
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Murray, K. T., Rottman, J. N., Arbogast, P. G., Shemanski, L., Primm, R. K., Campbell, W. B., ... Ray, W. A. (2004). Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM. Heart Rhythm, 1(6), 669-675. https://doi.org/10.1016/j.hrthm.2004.08.008
Murray, Katherine T. ; Rottman, Jeffrey N. ; Arbogast, Patrick G. ; Shemanski, Lynn ; Primm, R. Kirby ; Campbell, W. Barton ; Solomon, Allen J. ; Olgin, Jeffrey E. ; Wilson, Michael J. ; DiMarco, John P. ; Beckman, Karen J. ; Dennish, George ; Naccarelli, Gerald ; Ray, Wayne A. / Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM. In: Heart Rhythm. 2004 ; Vol. 1, No. 6. pp. 669-675.
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abstract = "Objectives: We investigated whether inhibition of endogenous angiotensin II signaling reduces the recurrence rate of atrial fibrillation (AF) in patients enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Background: Structural and electrical remodeling contribute to AF. Previous experimental studies have implicated the angiotensin II signaling pathway in this process, and recent clinical evidence supports a beneficial effect of inhibiting angiotensin II activity. Methods: Using the AFFIRM database, we retrospectively identified a cohort of patients randomized to the rhythm-control arm who were in sinus rhythm. Exposure to angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors (ANGI) was determined, and the time to first recurrence of AF was compared between ANGI users and nonusers. Results: The study cohort included 732 patients not taking ANGI through the initial 2-month follow-up and 421 patients taking ANGI during this time. Patients in the ANGI group more likely had hypertension, diabetes, coronary artery disease, and congestive heart failure compared to patients not taking ANGI. Risk of AF recurrence in the ANGI treatment group did not differ from the risk observed in patients not taking the drugs (hazard ratio [HR] = 0.91, 95{\%} confidence interval [CI] = 0.77-1.09). However, in patients with congestive heart failure or impaired left ventricular function, ANGI use was associated with a lower risk of AF recurrence. Conclusions: This analysis provides evidence that ANGI use may be beneficial in some patient subgroups with AF and underscores the need for randomized clinical trials defining more fully the role of angiotensin II inhibition in treating AF.",
author = "Murray, {Katherine T.} and Rottman, {Jeffrey N.} and Arbogast, {Patrick G.} and Lynn Shemanski and Primm, {R. Kirby} and Campbell, {W. Barton} and Solomon, {Allen J.} and Olgin, {Jeffrey E.} and Wilson, {Michael J.} and DiMarco, {John P.} and Beckman, {Karen J.} and George Dennish and Gerald Naccarelli and Ray, {Wayne A.}",
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Murray, KT, Rottman, JN, Arbogast, PG, Shemanski, L, Primm, RK, Campbell, WB, Solomon, AJ, Olgin, JE, Wilson, MJ, DiMarco, JP, Beckman, KJ, Dennish, G, Naccarelli, G & Ray, WA 2004, 'Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM', Heart Rhythm, vol. 1, no. 6, pp. 669-675. https://doi.org/10.1016/j.hrthm.2004.08.008

Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM. / Murray, Katherine T.; Rottman, Jeffrey N.; Arbogast, Patrick G.; Shemanski, Lynn; Primm, R. Kirby; Campbell, W. Barton; Solomon, Allen J.; Olgin, Jeffrey E.; Wilson, Michael J.; DiMarco, John P.; Beckman, Karen J.; Dennish, George; Naccarelli, Gerald; Ray, Wayne A.

In: Heart Rhythm, Vol. 1, No. 6, 01.12.2004, p. 669-675.

Research output: Contribution to journalArticle

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T1 - Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM

AU - Murray, Katherine T.

AU - Rottman, Jeffrey N.

AU - Arbogast, Patrick G.

AU - Shemanski, Lynn

AU - Primm, R. Kirby

AU - Campbell, W. Barton

AU - Solomon, Allen J.

AU - Olgin, Jeffrey E.

AU - Wilson, Michael J.

AU - DiMarco, John P.

AU - Beckman, Karen J.

AU - Dennish, George

AU - Naccarelli, Gerald

AU - Ray, Wayne A.

PY - 2004/12/1

Y1 - 2004/12/1

N2 - Objectives: We investigated whether inhibition of endogenous angiotensin II signaling reduces the recurrence rate of atrial fibrillation (AF) in patients enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Background: Structural and electrical remodeling contribute to AF. Previous experimental studies have implicated the angiotensin II signaling pathway in this process, and recent clinical evidence supports a beneficial effect of inhibiting angiotensin II activity. Methods: Using the AFFIRM database, we retrospectively identified a cohort of patients randomized to the rhythm-control arm who were in sinus rhythm. Exposure to angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors (ANGI) was determined, and the time to first recurrence of AF was compared between ANGI users and nonusers. Results: The study cohort included 732 patients not taking ANGI through the initial 2-month follow-up and 421 patients taking ANGI during this time. Patients in the ANGI group more likely had hypertension, diabetes, coronary artery disease, and congestive heart failure compared to patients not taking ANGI. Risk of AF recurrence in the ANGI treatment group did not differ from the risk observed in patients not taking the drugs (hazard ratio [HR] = 0.91, 95% confidence interval [CI] = 0.77-1.09). However, in patients with congestive heart failure or impaired left ventricular function, ANGI use was associated with a lower risk of AF recurrence. Conclusions: This analysis provides evidence that ANGI use may be beneficial in some patient subgroups with AF and underscores the need for randomized clinical trials defining more fully the role of angiotensin II inhibition in treating AF.

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Murray KT, Rottman JN, Arbogast PG, Shemanski L, Primm RK, Campbell WB et al. Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM. Heart Rhythm. 2004 Dec 1;1(6):669-675. https://doi.org/10.1016/j.hrthm.2004.08.008