Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers decrease the incidence of atrial fibrillation: a meta-analysis


Gang Huang, MD, Department of Cardiology, the Second People’s Hospital of Chengdu, Qin-yun-nan-jie Street, Jinjiang District, Chengdu 610017, Sichuan Province, China. Tel.: +86 28 86917030; fax: +86 28 86917030;
Akram Arkin, MD, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uyghur Autonomous Region, China. Tel.: +86 0991 2838906; fax: +86 0991 4324139; e-mail:


Eur J Clin Invest 2011; 41 (7): 719–733


Background  There is not a general agreement regarding antiarrhythmic effects on atrial fibrillation (AF) of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). This study was to assess whether ACEIs and ARBs could decrease the incidence of AF.

Materials and methods  Medline, Embase and Cochrane Library databases were searched for trials reported from 1950 to May 2009. Search terms included ‘randomized controlled trial (RCT), controlled clinical trials, random allocation’ and medical subject headings that included all spellings of ACEIs and ARBs agents, ‘atrial fibrillation’ and ‘atrial flutter’. Randomized, controlled human trials of ACEIs or ARBs reporting AF were included. Data were extracted independently by two reviewers using a predefined data extraction sheet, including study quality indicators. Meta-analysis and subgroup analyses were carried out with a random effects model.

Results  Twenty-one trials including 91 381 patients and 5730 AF events were identified. Overall, ACEIs/ARBs reduced the relative risk (c) of AF by 25%. In primary and secondary prevention, ACEIs/ARBs decreased the incidence of AF by 24% and 27%, respectively. Patients with hypertension (RR: 0·71, 95%CI: 0·54–0·92), patients with chronic heart failure (RR: 0·58, 95%CI: 0·39–0·87) and those with AF (RR: 0·71, 95%CI: 0·52–0·96) benefited from ACEIs/ARBs treatment.

Conclusions  ACEIs/ARBs are effective for primary prevention and secondary prevention of AF. They decrease the incidence of AF especially in patients with hypertension, patients with chronic heart failure and those with AF.