Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation. Results of a prospective and controlled study.
OBJECTIVE
This study aimed to assess whether enalapril could improve cardioversion outcome and facilitate sinus rhythm maintenance after conversion of chronic atrial fibrillation (AF).


RESULTS
Patients with chronic AF for more than 3 months were assigned to receive either amiodarone (200mg orally 3 times a day; group I: n=75) or the same dosage of amiodarone plus enalapril (10mg twice a day; group II: n=70) 4 weeks before scheduled external cardioversion. The end-point was the time to first recurrence of AF. In 125 patients (86.2%), AF was converted to sinus rhythm. Group II had a trend to a trend to a lower rate of immediate recurrence of AF than group I did (4.3% vs 14.7%, P=0.067). Kaplan-Meier analysis demonstrated a higher probability of group II remaining in sinus rhythm at 4 weeks (84.3% vs 61.3%, P=0.002) and at the median follow-up period of 270 days (74.3% vs 57.3%, P=0.021) than in group II.


CONCLUSIONS
The addition of enalapril to amiodarone decreased the rate of immediate and subacute arrhythmia recurrences and facilitated subsequent long-term maintenance of sinus rhythm after cardioversion of persistent AF.
Ueng
Kwo-Chang
KC
Division of Cardiology and Cardiovascular Surgery, Institute of Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan. ueng.kc@msa.hinet.net
Tsai
Tsung-Po
TP
Yu
Wen-Chung
WC
Tsai
Chin-Feng
CF
Lin
Ming-Cheng
MC
Chan
Kuei-Chuan
KC
Chen
Chung-Yin
CY
Wu
Der-Jinn
DJ
Lin
Chung-Sheng
CS
Chen
Shih-Ann
SA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D004554:Electric Countershock / Q000009:adverse effects / Q000379:methods*; D004656:Enalapril / Q000008:administration & dosage*; D006801:Humans; D008134:Long-Term Care; D008875:Middle Aged; D011446:Prospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D004656:Enalapril; D000638:Amiodarone