Perindopril for the prevention of atrial fibrillation recurrence after radiofrequency catheter ablation: One-year experience

BACKGROUND Recurrence of atrial fibrillation (AF) after ablation is still high. Perindopril plays an essential role in AF induction and maintenance. OBJECTIVE We aimed to prove that perindopril (8 mg) could prevent recurrence after pulmonary vein isolation. METHODS Patients with paroxysmal AF who received radio frequency ablation were randomized to a 3 -month course of perindopril 8 mg once daily (perindopril group) or placebo (placebo group). Angiotensin-II (Ang-II) therapy and standard transthoracic echocardiography were performed. All 256 patients with paroxysmal AF who received radiofrequency ablation were randomized. And we followed them for complete 1 year. The 3 -month recurrence and the 1 -year recurrence were compared between the 2 groups. RESULTS The 3 -month recurrence of AF was observed in 33 (26.19%) of 126 patients in the placebo group vs 19 (14.62%) 130 patients who received perindopril 8 mg once daily (x2, P =.021). One-year recurrence of AF was observed in 36 (28.5%) of 126 patients in the placebo group as compared with 21 (16.2%) of 130 patients who received perindopril after 1 year (P =.017). The kappa value was 0.94 in the control group (P <.001) and 0.96 in the perindopril group (P <.001) between 3 -month and 1 -year recurrence. The Ang-II level was related to the left atrial distance with the reduction in AF recurrence (r = 0.17, P =.005 at 3 months; r = 0.25, P <.001 at 1 year). CONCLUSION Perindopril is an effective and safe treatment for the prevention of AF recurrence after radiofrequency catheter ablation. This effect seems to be strongly associated with a significant decrease in Ang-II level and left atrial distance.