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J Cardiovasc Pharmacol. 2019 Feb 8. doi: 10.1097/FJC.0000000000000659. [Epub ahead of print]

Prognostic Impact of Angiotensin Converting Enzyme Inhibitors and Receptor Blockers on Recurrent Ventricular Tachyarrhythmias and ICD Therapies.

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First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany.
T.S. and M.Be. contributed equally to this study.
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.
Department of Cardiology and Angiology II, University Heart Center Freiburg.


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 to patients without (non-ACEi/ARB). The primary prognostic endpoint was first recurrences 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 ACEiARB and 19% without). Although ACEi/ARB was associated with no differences of overall recurrence of ventricular tachyarrhythmias, ACEi/ARB was especially associated with improved freedom from appropriate ICD therapy within multivariable Cox regressions (HR=0.666; p=0.043), especially in patients with index episodes of VF, LVEF <35%, coronary artery disease, secondary preventive ICDs and GFR <45 ml/min/1.73m.In the propensity-matched sub-group, ACEi/ARB still prolonged freedom from appropriate ICD therapies (HR=0.380; 95% CI 0.193-0.747; p=0.005).In conclusion, ACEi/ARB therapy was associated with improved freedom from appropriate ICD therapies.

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