Research Study Summary
A clinical trial to evaluate treatments using Ramipril and Placebo for patients with Atrial Fibrillation or Atrial Flutter
Research Study Title
Prevention of Atrial Fibrillation by the Prescription of Inhibition Conversion Enzyme (ICE) After Radiofrequency Ablation of Atrial Flutter
Atrial Flutter [AFL] is a relatively frequent arrhythmia, considered as benign, but
associated with both invalidating symptoms and thromboembolic risk. The objective of the
treatment consists to on the one hand the sinus rhythm [SR] restoration and on the other
hand the prevention of the long-term recurrence. In this clinical setting, AFL
radiofrequency ablation [RFA] became the first line therapy due to its both high
effectiveness and safety. The effectiveness of AFL RFA is attenuated by the subsequent risk
of atrial fibrillation [AFib] close to 25% at 1 year. This risk of subsequent AFib is
related to the common substrate between both arrhythmias.
When AFib occurs, the interest to maintain the SR is still required, even if recent studies
did not show a significant difference in term of total mortality between rate or rhythm
control strategies [AFFIRM, RACE and PIAF studies]. The studies published underlined the
anti-arrhythmic drugs limits in patients with both arrhythmias [AFib and AFL]. After years
centered on the mechanisms and the electric treatments of AFib, researchers are nowadays
focusing on the study's evaluation of the atrial tissue substrate.
Accordingly, the renin-angiotensin system role was investigated in many works. Indeed,
angiotensin II plays a role in the modification of atrial pressure and in the fibers
stretching ["stretch"], conditions required for the development of AFib. Angiotensin II is
also a factor implied in the tissue fibrosis leading to tissue proliferation and collagen
alteration. These mechanisms lead to atria cells conduction disorders and refractory periods
modification. Moreover, the enzyme of conversion expression and the angiotensin II receptors
deterioration were observed in patients with AFib.
This brings to the concept of AFib treatment while interfering on tissue remodeling by the
way of renin-angiotensin system. Drugs such as the angiotensin converting enzyme inhibition
[ACEI] may reduce AFib in patients with heart failure. No randomized study so far has
compared the ACEI drugs against placebo among high-risk patients of AFib in post AFL RFA
area. On the basis of experimental and clinical study, the investigators seek to evaluate
the ACEI use in the prevention of AFib in an AFL post RFA ablation.
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