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Is there a relation between atrial fibrillation and the renine-angiotensin-aldosterone system? Volume 4, issue 3, Mai-Juin 2008

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Authors
Service de cardiologie, Hôpital Universitaire Côte de Nacre, Caen, INSERM U689, Hôpital Lariboisière, Paris

Atrial fibrillation (AF) is the most frequent supraventricular tachycardia in clinical practice and is an independent predictor of both stroke and death. In patients with congestive heart failure (CHF), AF is also frequently observed and is responsible for increased hospitalizations and worsening of functional status and prognosis. In this setting, AF occurrence is related to multiple and various factors such as histological and electrical remodelling, hemodynamic condition, autonomic nervous system balance and inflammation. Considering medical options, only amiodarone is indicated, with a moderate efficacy and tolerance. Future alternatives such as AF ablation seems attractive, but further evaluation is needed. For several years, a growing interest in AF prevention by using renine-angiontensin-aldosterone system (RAAS) blockers has emerged, following clinical as well as experimental studies. All these RAAS blockers showed beneficial effects on AF occurrence, with pleïotropic actions not only at the « channel » level, like other anti-arrhythmic drugs, but also on different factors of AF substrate (inflammation, oxidative stress…). In addition, their absence of pro-arrhythmogenic effects, leads to safe and simple prescription of these drugs. However, further assessment is needed before claiming an « anti-arrhythmic » effect of these RAAS blockers. This paper summarizes the different clinical and experimental studies on AF prevention by RAAS blockers, and aims to give insight on the relationship between RAAS and FA, and the pathophysiological hypothesis of such beneficial effects on AF occurrence.