[Upstream therapy for atrial fibrillation].

Upstream therapy to prevent atrial remodeling associated with hypertension, heart failure, or inflammation may deter the development of new AF or rate of recurrence or progression to permanent AF. Treatments with ACEI, ARB, and statins are usually referred to as upstream therapies for AF. There is a sustained reduction in new-onset AF in patients with significant underlying heart disease treated with ACEI or ARB, but evidence is less robust in patients with moderate structural heart disease and recurrent AF. Evidence in support of the use of statins for prevention of AF, except for post-operative AF, is insufficient to produce any robust recommendation. There is as yet no consensus regarding the intensity and duration of treatment and type of statins.