Background: Heart failure (HF) and atrial fibrillation (AF) share several risk factors including coronary artery disease, hypertension, smoking, obesity, diabetes, and renal disease, as well as common pathophysiologic pathway involving activation of the renin–angiotensin–aldosterone system, maladaptive atrial remodeling and subsequent impaired conduction system. Some studies have supported the role of angiotensin converting enzyme inhibitors (ACEIs) in preventing new onset of AF or reducing cardiovascular burden of recurrent AF although this appears to be limited to patients with systolic left ventricular dysfunction in whom this class of therapy is already indicated. The role of ACEIs in preventing or decreasing burden of AF specifically in patients with heart failure with preserved ejection fraction (HFpEF) has been very limitedly studied.

Methods: The data of The Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial (n=3445) was used in this study. Propensity scores were estimated from 54 variables and utilized to assemble a matched cohort to examine the effect of ACEI in reducing the risk of new onset atrial fibrillation.

Results: The total number of subjects in the matched cohort was 2024 subjects. 1012subjects were on ACEI and 1012 subjects were not on ACEI. There was no statistically significant difference between the baseline characteristics between subjects who received ACEI and subjects who did not received ACEI in the matched cohort. McNemar’s test showed that the rate of new atrial fibrillation was significantly lower in subjects who were on ACEI (5.9%) compared to subjects who were not on ACEI (9.4%) (p-value < 0.01).

Conclusions: Subjects with HFpEF who were on ACEI had a significant reduction in the rate of new-onset atrial fibrillation compared to subjects who were not.