Regression of LVH and AF

Q: Regression of Left Ventricular Hypertrophy (LVH)? (select one)

A) decreases the frequency of paroxysmal atrial fibrillation

B) increases the frequency of paroxysmal atrial fibrillation

Answer: A

The objective of this question is to introduce students to the effect of angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on reduction of atrial fibrillation with re-modelling of heart, or to be precise with regression of LVH. 

This effect is pure mechanical due to reduction in left atrial pressure as well as diameter. The biggest advantage is in the reduce frequency of new onset AF. ACEIs and ARBs have similar effect in this regard. This advantage is found to be more pronounced in patients with heart failure.

#cardiology

References:

1. Hennersdorf MG, Schueller PO, Steiner S, Strauer BE. Prevalence of paroxysmal atrial fibrillation depending on the regression of left ventricular hypertrophy in arterial hypertension. Hypertens Res 2007; 30:535.

2. Okin PM, Wachtell K, Devereux RB, et al. Regression of electrocardiographic left ventricular hypertrophy and decreased incidence of new-onset atrial fibrillation in patients with hypertension. JAMA 2006; 296:1242.

3. Healey JS, Baranchuk A, Crystal E, et al. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis. J Am Coll Cardiol 2005; 45:1832.