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Background and Objectives: Paroxysmal atrial fibrillation (PAF) is a common cardiac arrhythmia closely associated with significant cardiovascular risk. Angiotensin-converting enzyme inhibitors (ACEIs) such as benazepril can improve atrial remodeling and microvascular function, whereas amiodarone is a standard antiarrhythmic agent. However, the synergistic effect of their combined use on paroxysmal arrhythmia burden and microvascular pathology‑related factors remains unclear. This study aims to evaluate the clinical efficacy of benazepril combined with amiodarone in patients with PAF, with a focus on arrhythmia control and biomarkers of microvascular injury.   Methods: A total of118 PAF patients at Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital) from 2021 to 2023were randomly grouped: Amiodarone monotherapy group (AG), benazepril and amiodarone combination group (CG). The effects of the two treatment methods were evaluated by monitoring the frequency of atrial arrhythmias, the recurrence rate of PAF, changes in left atrial size, the maintenance rate of sinus rhythm, and the levels of microvascular lesion-related factors.   Results: The recurrence rate of PAF in CG was markedly lower as against AG; The maintenance rate of sinus rhythm in AG at the 12th month following remedy was 55.17% (32/58), and in CG it was 75.0% (45/60); The levels of soluble urokinase-type plasminogen activator receptor (suPAR), soluble ST2 (sST2), and interleukin-6 (IL-6) between the two groups following remedy were markedly different (P <0.05). The total effective rate of CG (93.33%) was markedly higher than that of AG (81.03%).    Conclusion: The treatment of benazepril plus amiodarone can markedly reduce the incidence of atrial arrhythmias in patients with PAF and improve the levels of factors related to microvascular lesions, suggesting the potential clinical application value of this combined regimen in PAF patients.