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In 2005, a meta-analysis of angiotensin-converting enzyme (ACE) inhibitor and angiotensin-receptor blocker (ARB) trials suggested that blockade of the renin-angiotensin-aldosterone system (RAAS) prevents atrial fibrillation (AF) in patients with heart failure (HF) or left ventricular dysfunction. In the industry-sponsored ACTIVE I trial, investigators randomized patients with permanent AF or at least two episodes of AF in the previous 6 months to irbesartan or placebo. The two primary endpoints were the composite of myocardial infarction, stroke, and death from vascular causes, (1) including and (2) not including hospitalization for HF. A secondary endpoint was recurrence of AF in patients who were in sinus rhythm at study entry.
At baseline…