The aim of AF treatment is to reduce morbidity and mortality, and the application of anticoagulant drugs warfarin and dabigatran and antiarrhythmic drug dronedarone have demonstrated this role in the treatment of AF. In addition to this, this conference paid special attention to the study of AF substrate and AF atrial muscle remodeling, including hypertension combined with AF and cardiac insufficiency combined with AF, which can lead to AF substrate and AF atrial muscle remodeling. Atrial fibrillation after cardiac surgery, on the other hand, may be related to inflammation. Treatments that target the remodeling of the AF substrate and AF myocardium as well as the inflammatory response that leads to AF are also known as upstream pharmacologic treatments for AF. The following drugs are used to prevent remodeling of AF atrial muscle: A, angiotensin-converting enzyme inhibitors; B, angiotensin receptor blockers; C, aldosterone receptor antagonists; D, statins; E, corticosteroids; and F, N-3 polyunsaturated fatty acids. And the combination may work together to prevent and treat atrial fibrillation through different mechanisms. Prof. John Camm from London, England, reported on upstream pharmacotherapy for AF, focusing on the role of ACEI/ARB in primary and secondary prevention of AF. Several small studies (see table below) have shown the benefit of ACEI/ARB in the primary and secondary prevention of AF. Note: AF: atrial fibrillation; CHF: congestive heart failure; LVD: left ventricular dysfunction; NSR: sinus arrhythmia; post-MI: post-infarction; HTN: hypertension In terms of primary prevention of AF, three meta-analyses have shown that ACEIs/ARBs are able to reduce the occurrence of AF by approximately 30-45%. However, it should be emphasized that these benefits of ACEI/ARB may be associated with an improvement in left ventricular systolic function reduction, as the reduction in the incidence of AF in patients with less pronounced heart failure is less pronounced. With regard to secondary prevention of AF, 2 meta-analyses have shown that ACEIs/ARBs reduce the incidence of AF by approximately 50%. However, a recently published double-blind controlled study applying valsartan versus placebo showed that valsartan did not have a preventive effect on the occurrence of AF. At the conference, Prof. S.J. Connolly of Hamilton, Canada, presented the latest ACTIVE I study, which was designed to evaluate the effect of irbesartan 150-300 mg daily on the prevention of vascular events in patients with atrial fibrillation. 9016 patients with atrial fibrillation were enrolled in the study, which was conducted in 35 countries and is the largest study of atrial fibrillation conducted to date using ACEI/AR It is the largest study of ACEI/ARB in AF to date. The study was conducted with Irbesartan 150-300mg daily versus placebo control on the basis of ACTIVE A and ACTIVE W. The follow-up was close to 4 years. Inclusion criteria: A: systolic blood pressure greater than or equal to 110 mmHg and no clear indication for an ARB; B: all patients already enrolled in the ACTIVE A or ACTIVE W studies but definitely not on an ACEI; C: evidence of high-risk vascular events. Primary composite endpoint: stroke/myocardial infarction/death from other vascular events; secondary composite endpoint: stroke/myocardial infarction/death from other vascular events/hospitalization due to heart failure.The results of the ACTIVE I study showed that the primary composite endpoint of stroke/myocardial infarction/death from other vascular events was not statistically different from the placebo control (p=0.122); however, the secondary composite endpoint was significantly lower compared to the placebo control (p=0.122). was significantly lower (p = 0.015), and patients were hospitalized for heart failure by 14% less.