Blockade of renin–angiotensin system: A supplementary treatment for circumferential pulmonary vein isolation in treating persistent atrial fibrillation

SummaryThe development of atrial fibrillation ablation has revolutionized the field of antiarrhythmic treatment by reducing the recurrence of atrial fibrillation (AF) significantly in patients with paroxysmal atrium fibrillation (PAF). However, the effect of ablation on the patients with persistent atrial fibrillation (PeAF) is not as good as it on PAF. Although doctors have created a series of ablation strategy, they still cannot treat PeAF effectively.This phenomenon is caused by structural remodeling and electrical remodeling of atrium during the long period of AF. Many experimental have demonstrated remodeling of atrium correlated with high level of angiotensin in atrial tissue, and blockade of renin–angiotensin system (RAS) through angiotensin-converting-enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) can reverse atrial remodeling. Clinical studies also confirmed that blockade of RAS can prevent AF effectively.Thus, for the object of treating PeAF effectively, we can combine the circumferential pulmonary vein isolation with blockade of RAS treatment, this combined strategy eliminate the trigger (pulmonary vein potential ) of AF and reverse the atrial remodeling, may be have a good effect on PeAF.