Background: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered clinically in patients with congestive heart failure (CHF) and has been associated with increased morbidity and possibly mortality. Small retrospective studies have shown a preventive effect on AF development with the use of agents interfering with the renin-angiotensin system (RAS). Method and Results:We carried out a systematic search of the literature in the English language in order to elucidate the potential mechanism underlying this added beneficial effect of RAS inhibitors in CHF. The concepts of ionic, electrical and structural remodelling of the atrium induced by AF are discussed. Conclusion: Inhibition of RAS could prevent AF development in patients with CHF.

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