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Atrial fibrillation in heart failure patients: An update on renin–angiotensin–aldosterone system pathway blockade as a therapeutic and prevention target
Affiliations- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
- Department of Internal Medicine, University Hospital of Patras, Greece
- Department of Cardiology, University Hospital of Patras, Greece
- Department of Surgery, University Hospital of Patras, Greece
- Krankenhaus der Barmherzigen Brüder Trier, Germany
- Department of Cardiothoracic Surgery, University Hospital of Patras, Greece
open access
Abstract
Heart failure (HF) and atrial fibrillation (AF) are two cardiovascular (CV) entities that affect millions
of individuals worldwide and their prevalence is translated into a significant impact on health care systems.
The common pathophysiological pathways that these two share have created an important clinical
interrelation, as the coexistence of HF and AF is associated with worse prognosis and treatment challenges.
Renin–angiotensin–aldosterone system (RAAS), a critical mechanism in blood pressure (BP)
control, was proved to be involved in the pathogenesis of both conditions contributing to their further
coexistence. Successful control of BP is of great importance to the management of HF, crucial for the
prevention of arrhythmiogenic substrates, while RAAS antagonists may possibly affect the development
of new-onset AF as well. There are numerous studies that evaluated the effectiveness of RAAS blockade
in AF/HF population and despite comparable or modest results, there is a well-established suggestion
that RAAS blockers may contribute to a reduction of HF, CV events and recurrence of AF, along with
their potential effective role in the new-onset AF prophylaxis. Angiotensin receptor blockers, according to
the evidence, are more effective in that direction, followed by angiotensin converting enzyme inhibitors,
whereas the data on aldosterone antagonists are not encouraging, yet do have the potential of significant
CV disease modificators regardless of their effects on BP.
Abstract
Heart failure (HF) and atrial fibrillation (AF) are two cardiovascular (CV) entities that affect millions
of individuals worldwide and their prevalence is translated into a significant impact on health care systems.
The common pathophysiological pathways that these two share have created an important clinical
interrelation, as the coexistence of HF and AF is associated with worse prognosis and treatment challenges.
Renin–angiotensin–aldosterone system (RAAS), a critical mechanism in blood pressure (BP)
control, was proved to be involved in the pathogenesis of both conditions contributing to their further
coexistence. Successful control of BP is of great importance to the management of HF, crucial for the
prevention of arrhythmiogenic substrates, while RAAS antagonists may possibly affect the development
of new-onset AF as well. There are numerous studies that evaluated the effectiveness of RAAS blockade
in AF/HF population and despite comparable or modest results, there is a well-established suggestion
that RAAS blockers may contribute to a reduction of HF, CV events and recurrence of AF, along with
their potential effective role in the new-onset AF prophylaxis. Angiotensin receptor blockers, according to
the evidence, are more effective in that direction, followed by angiotensin converting enzyme inhibitors,
whereas the data on aldosterone antagonists are not encouraging, yet do have the potential of significant
CV disease modificators regardless of their effects on BP.
Keywords
renin–angiotensin–aldosterone system (RAAS) blockers, atrial fibrillation, heart failure, angiotensin receptor blockers (ARBs), angiotensin converting enzyme inhibitors (ACEIs), aldosterone antagonists (AAs)
About this articleTitle
Atrial fibrillation in heart failure patients: An update on renin–angiotensin–aldosterone system pathway blockade as a therapeutic and prevention target
Journal
Issue
Article type
Review Article
Pages
312-326
Published online
2022-06-23
Page views
3462
Article views/downloads
587
DOI
10.5603/CJ.a2022.0061
Pubmed
Bibliographic record
Cardiol J 2023;30(2):312-326.
Keywords
renin–angiotensin–aldosterone system (RAAS) blockers
atrial fibrillation
heart failure
angiotensin receptor blockers (ARBs)
angiotensin converting enzyme inhibitors (ACEIs)
aldosterone antagonists (AAs)
Authors
Ioanna Koniari
Eleni Artopoulou
Virginia Mplani
Francesk Mulita
Evangelia Alexopoulou
Emmanouil Chourdakis
Mohammed Abo-Elseoud
Grigorios Tsigkas
Ioannis Panagiotopoulos
Nicholas Kounis
Dimitrios Velissaris
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