Atrial Substrate Modification With Aggressive Blood Pressure Lowering to Prevent AF (SMAC AF)
Atrial Fibrillation
About this trial
This is an interventional prevention trial for Atrial Fibrillation focused on measuring blood pressure, atrial fibrillation, catheter ablation
Eligibility Criteria
Inclusion Criteria:
- Documented systolic blood pressure greater than or equal to 130 mmHg
- Undergoing planned catheter ablation for persistent AF (lasting > 7 days and < 365 days or requiring electrical or chemical cardioversion) OR High burden paroxysmal AF > 6 months (greater than or equal to 3 symptomatic episdes in past 6 months and refractory or inteolerant to at least 1 class 1 or 3 antiarrhythmic)
Exclusion Criteria:
- Permanent atrial fibrillation
- Contraindication to Accupril or any other ACE-I
- Women of child-bearing potential
- Life expectancy less than 1 year
- Less than 18 years of age
- Unable to give informed consent
- Known moderate to several renal dysfunction (eGFR < 30 ml/min/1.73m2)
- Prior AF catheter ablation
Sites / Locations
- QE II Health Sciences Centre
Arms of the Study
Arm 1
Arm 2
Active Comparator
No Intervention
Aggressive Blood Pressure control
Standard Blood Pressure control
The experimental arm will receive open label therapy to achieve a target systolic blood pressure less than or equal to 120 mmHg. If the average BP is found to be > 120 mmHg at the baseline, telephone or clinic followup visits, treatment will be recommended based on the following regimen (For details, please see Appendix 4): Step 1 - Accupril, titrated to maximum tolerated dose, beginning at 20 mg po od followed by 40 mg successively Step 2 - combination of Accupril with Hydrochlorothiazide 12.5 mg po od. Step 3 - Addition of Atenolol 50 mg po od. Step 4 - Addition of Norvasc 2.5-10 mg po od. Step 5 - Addition of Terazosin 1 mg po od.
Treatment will be carried out as per the CHEP guidelines. These patients may require ACEi or ARBs for their treatment. No changes to their drug regimen will be made as long as BP measurements are congruent with current guidelines. These modifications will be made as per standard practice by the physician who is primarily involved with their care (this may be a family physician or a specialist, depending on the patient). Patients with diabetes in the standard arm will be treated to a target BP of <130/80 as per the CHEP guidelines.