Upstream therapy for atrial fibrillation in heart failure.

Atrial fibrillation (AF) is a common arrhythmia that occurs as the result of various pathophysiologic processes. Heart failure increases the likelihood of AF. Several aspects of the morphologic and electrophysiologic alterations promoting AF in heart failure (congestive heart failure [CHF]) have been studied in animal models and patients with CHF. Under these conditions, ectopic activity originating from the pulmonary veins or other sites is more likely to occur and trigger longer episodes of AF. This article summarizes the impact of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and statins, so-called upstream therapy, in patients who have CHF with AF.