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Prognostic Impact of Angiotensin-Converting Enzyme Inhibitors and Receptor Blockers on Recurrent Ventricular Tachyarrhythmias and Implantable Cardioverter–Defibrillator Therapies

Schupp, Tobias, MS*; Behnes, Michael, MD*; Weiß, Christel, PhD; Nienaber, Christoph, MD; Lang, Siegfried, PhD*; Reiser, Linda, MS*; Bollow, Armin, MS*; Taton, Gabriel, MS*; Reichelt, Thomas, MS*; Ellguth, Dominik, MD*; Engelke, Niko, MS*; Bertsch, Thomas, MD§; Akin, Muharrem, MD; Mashayekhi, Kambis, MD; Borggrefe, Martin, MD*; Akin, Ibrahim, MD*

Journal of Cardiovascular Pharmacology: May 2019 - Volume 73 - Issue 5 - p 272–281
doi: 10.1097/FJC.0000000000000659
Original Article
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Abstract: This study sought to assess the prognostic impact of treatment with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) on recurrences of ventricular tachyarrhythmias in recipients of implantable cardioverter–defibrillators (ICD). Using a large retrospective registry including consecutive ICD recipients with documented episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2016, those patients treated with ACEi/ARB were compared with patients without. The primary prognostic endpoint was the first recurrence of ventricular tachyarrhythmias and related ICD therapies at 5 years. Multivariable Cox regression analyses were applied within the entire cohort, and thereafter, Kaplan–Meier analyses were performed in propensity-matched subgroups. A total of 592 consecutive ICD recipients were included (81% treated with ACEi/ARB and 19% without). Although ACEi/ARB was associated with no differences in overall recurrence of ventricular tachyarrhythmias, ACEi/ARB was associated with improved freedom from appropriate ICD therapy within multivariable Cox regressions (hazard ratio = 0.666; P = 0.043), especially in patients with index episodes of VF, left ventricular ejection fraction <35%, coronary artery disease, secondary preventive ICD, and glomerular filtration rate <45 mL/min/1.73 m2. In the propensity-matched subgroup, ACEi/ARB still prolonged freedom from appropriate ICD therapies (hazard ratio = 0.380; 95% confidence interval 0.193–0.747; P = 0.005). In conclusion, ACEi/ARB therapy was associated with improved freedom from appropriate ICD therapies.

*First Department of Medicine, University Medical Centre Mannheim (UMM), European Center for AngioScience (ECAS), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany;

Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany;

Royal Brompton and Harefield Hospitals, NHS, London, United Kingdom;

§Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany;

Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; and

Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany.

Reprints: Michael Behnes, MD, First Department of Medicine, University Medical Center Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany (e-mail: michael.behnes@umm.de).

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcvp.org).

T. Schupp and M. Behnes contributed equally to this study.

Received August 02, 2018

Accepted December 31, 2018

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