Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction.

BACKGROUND Studies have suggested that ACE inhibitors have an antiarrhythmic effect on ventricular arrhythmias. Whether they have an effect on atrial fibrillation is unknown. METHODS AND RESULTS We investigated the effect of ACE inhibition with trandolapril on the incidence of atrial fibrillation in patients with reduced left ventricular function secondary to acute myocardial infarction. The patients in this study were those who qualified for inclusion into the TRAndolapril Cardiac Evaluation (TRACE) study, a randomized double-blind placebo-controlled study and who had sinus rhythm on the ECG obtained at randomization. Patients who fulfilled the criteria for inclusion were randomized to treatment with the ACE inhibitor trandolapril or placebo and were followed up for 2 to 4 years. Development and time to occurrence of atrial fibrillation in one 12-lead ECG recorded at the outpatient visits was the primary end point of this investigation. Of the 1749 patients included in the TRACE study, 1577 had sinus rhythm on the ECG recorded at randomization. Of these patients, 790 were randomized to trandolapril treatment and 787 to placebo treatment. The groups differed only slightly with respect to baseline characteristics. A total of 64 patients developed atrial fibrillation during the 2- to 4-year follow-up period. Significantly more patients developed atrial fibrillation in the placebo group than in the trandolapril group, 5.3% (n=42) versus 2.8% (n=22), respectively, P<0.05. Cox multivariable regression analysis, adjusting for important baseline characteristics, revealed that trandolapril treatment significantly reduced the risk of developing atrial fibrillation (RR, 0.45; 95% CI, 0.26 to 0.76; P<0.01). CONCLUSIONS The results from the present study demonstrate that trandolapril treatment reduces the incidence of atrial fibrillation in patients with left ventricular dysfunction after acute myocardial infarction.

[1]  L. Køber,et al.  The occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction. TRACE Study group. TRAndolapril Cardiac Evalution. , 1999, European heart journal.

[2]  D. Levy,et al.  Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. , 1998, Circulation.

[3]  V. Boyko,et al.  Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. , 1998, Circulation.

[4]  M. Allessie,et al.  Effects of atrial dilatation on refractory period and vulnerability to atrial fibrillation in the isolated Langendorff-perfused rabbit heart. , 1997, Circulation.

[5]  R. Califf,et al.  Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries. , 1997, Journal of the American College of Cardiology.

[6]  R. Campbell.  ACE inhibitors and arrhythmias , 1996, Heart.

[7]  A. Budaj,et al.  Effects of captopril on ventricular arrhythmias in the early and late phase of suspected acute myocardial infarction. Randomized, placebo-controlled substudy of ISIS-4. , 1996, European Heart Journal.

[8]  E. Aliot,et al.  A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group. , 1995, The New England journal of medicine.

[9]  H. Crijns,et al.  Effects of lisinopril in patients with heart failure and chronic atrial fibrillation. , 1995, Journal of cardiac failure.

[10]  L. Køber,et al.  An echocardiographic method for selecting high risk patients shortly after acute myocardial infarction, for inclusion in multi-centre studies (as used in the TRACE study). TRAndolapril Cardiac Evaluation. , 1994, European heart journal.

[11]  K. Thygesen,et al.  Ventricular Arrhythmias in the Acute and Chronic Phases After Acute Myocardial Infarction: Effect of Intervention With Captopril , 1994, Circulation.

[12]  G. Lamas,et al.  Quantitative Two-Dimensional Echocardiographic Measurements are Major Predictors of Adverse Cardiovascular Events After Acute Myocardial Infarction: The Protective Effect of Captopril , 1994, Circulation.

[13]  A. Schömig,et al.  Quinapril therapy in patients with chronic mitral regurgitation. , 1994, The Journal of heart valve disease.

[14]  O. Hauswirth,et al.  Fosinoprilate prolongs the action potential: reduction of iK and enhancement of the L-type calcium current in guinea pig ventricular myocytes. , 1994, Cardiovascular research.

[15]  The TRAndolapril Cardiac Evaluation (TRACE) study: rationale, design, and baseline characteristics of the screened population. The Trace Study Group. , 1994, The American journal of cardiology.

[16]  J. Cohn,et al.  Enalapril Decreases Prevalence of Ventricular Tachycardia in Patients With Chronic Congestive Heart Failure , 1993, Circulation.

[17]  J. Rouleau,et al.  The antiarrhythmic effect of the ACE inhibitor captopril in patients with congestive heart failure largely is due to its potassium sparing effects. , 1992, The Canadian journal of cardiology.

[18]  A. Camm,et al.  Comparative electrophysiological effects of captopril or hydralazine combined with nitrate in patients with left ventricular dysfunction and inducible ventricular tachycardia. , 1992, British heart journal.

[19]  P. Andersen,et al.  Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis. , 1992, Cardiology.

[20]  E. Pilger,et al.  Acute effects of the ACE inhibitorlisinopril on cardiac electrophysiological parameters of isolated guinea pig hearts , 1991, Clinical cardiology.

[21]  F. Solti,et al.  The effect of atrial dilatation on the genesis of atrial arrhythmias. , 1989, Cardiovascular research.

[22]  R. Erbel,et al.  Atrial fibrillation in acute-phase myocardial infarction , 1989 .

[23]  M. Nicholls,et al.  Effect of enalapril on ventricular arrhythmias in congestive heart failure. , 1985, The American journal of cardiology.

[24]  T. Iwasaka,et al.  Atrial fibrillation in acute myocardial infarction. , 1985, The American journal of cardiology.

[25]  J. Conway,et al.  Interaction of angiotensin-converting enzyme inhibitors with the function of the sympathetic nervous system. , 1982, The American journal of cardiology.