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Angiotensin Converting Enzyme Inhibitors versus Receptor Blockers in Patients with Ventricular Tachyarrhythmias

Tobias Schupp1, Michael Behnes1, Mohammad Abumayyaleh1

  • 1First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.

Journal of Clinical Medicine
|March 10, 2022
PubMed

Insights

Angiotensin converting enzyme inhibitors (ACEi) and receptor blockers (ARB) show similar long-term mortality and arrhythmic event risks in patients with ventricular tachyarrhythmias. ACEi, however, was linked to reduced cardiac rehospitalization rates.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Angiotensin converting enzyme inhibitors (ACEi) and receptor blockers (ARB) are primarily studied for heart failure and myocardial infarction.
  • Limited data exist on their role in secondary prevention of sudden cardiac death (SCD) by reducing ventricular tachyarrhythmias.
  • ACEi/ARB may prevent adverse cardiac remodeling, potentially lowering the risk of ventricular tachyarrhythmias and SCD.

Purpose of the Study:

  • To investigate the comparative prognostic role of ACEi versus ARB in patients experiencing ventricular tachyarrhythmias (VT/VF).
  • To assess the impact of ACEi and ARB on all-cause mortality, arrhythmic events, and cardiac rehospitalization.

Main Methods:

  • A large retrospective registry analysis of patients with VT or VF from 2002 to 2015.
  • Primary outcome: all-cause mortality at three years.
  • Secondary outcomes: composite arrhythmic endpoint (VT/VF recurrence, ICD therapies, SCD) and cardiac rehospitalization.

Main Results:

  • 1236 patients were included; 85% received ACEi, 15% ARB.
  • No significant difference in three-year all-cause mortality (20% vs. 17%) or composite arrhythmic endpoint risk between ACEi and ARB groups.
  • ACEi use was associated with a significantly decreased risk of cardiac rehospitalization at three years (HR=0.690).
  • Propensity score matched analysis confirmed comparable long-term outcomes.

Conclusions:

  • ACEi and ARB demonstrate comparable efficacy regarding long-term mortality and arrhythmic events in patients with ventricular tachyarrhythmias.
  • ACEi may offer a benefit in reducing cardiac rehospitalization compared to ARB in this patient population.
  • Further research could explore mechanisms behind reduced rehospitalization with ACEi.

Keywords:
ACE inhibitorARBmedical treatmentmortalitypharmacological drugsventricular fibrillationventricular tachycardia

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