Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation: a prospective and randomized study.
BACKGROUND
Data from studies of angiotensin-converting enzyme inhibitors provide evidence that the renin-angiotensin-aldosterone system plays a role as a mediator of atrial remodeling in atrial fibrillation. The present study has evaluated the effect of treatment with the angiotensin I type 1 receptor blocker irbesartan on maintaining sinus rhythm after conversion from persistent atrial fibrillation.


RESULTS
To be included in the present study, patients must have had an episode of persistent atrial fibrillation for >7 days. The patients were then randomized and scheduled for electrical cardioversion. Two groups of patients were compared: Group I was treated with amiodarone, and group II was treated with amiodarone plus irbesartan. The primary end point was the length of time to a first recurrence of atrial fibrillation. From a total of 186 patients assessed in the study, 154 were analyzed with the use of intention-to-treat analysis. Seventy-five patients were randomly allocated to group I and 79 to group II. After 2 months of follow-up in the intention-to-treat analysis, the group treated with irbesartan had fewer patients with recurrent atrial fibrillation (Kaplan-Meier analysis, 84.79% versus 63.16%, P=0.008). The Kaplan-Meier analysis of time to first recurrence during the follow-up period (median time, 254 days [range, 60 to 710]) also showed that patients treated with irbesartan had a greater probability of remaining free of atrial fibrillation (79.52% versus 55.91%, P=0.007).


CONCLUSIONS
Patients treated with amiodarone plus irbesartan had a lower rate of recurrence of atrial fibrillation than did patients treated with amiodarone alone.
Arrhythmia Unit, Cardiology Department, Ramon y Cajal Hospital, Department of Medicine, Alcala University, Madrid, Spain.
Antonio H
AH
Madrid
Manuel G
MG
Bueno
Jose M G
JM
Rebollo
Irene
I
Marín
Gonzalo
G
Peña
Enrique
E
Bernal
Aníbal
A
Rodriguez
Lucas
L
Cano
José M
JM
Cano
Pedro
P
Cabeza
Concepción
C
Moro
D000328:Adult; D000368:Aged; D000638:Amiodarone / Q000009:adverse effects / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D001713:Biphenyl Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077405:Irbesartan; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D010507:Periodicity; D044140:Receptor, Angiotensin, Type 1; D012008:Recurrence; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use*
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D001713:Biphenyl Compounds; D044140:Receptor, Angiotensin, Type 1; D013777:Tetrazoles; D000077405:Irbesartan; D000638:Amiodarone