title: Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation. Results of a prospective and controlled study.
abstract: 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.
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Institute of Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan. ueng.kc@msa.hinet.net
authors.forename: Kwo-Chang
authors.initials: KC
authors.lastname: Ueng
authors.forename: Tsung-Po
authors.initials: TP
authors.lastname: Tsai
authors.forename: Wen-Chung
authors.initials: WC
authors.lastname: Yu
authors.forename: Chin-Feng
authors.initials: CF
authors.lastname: Tsai
authors.forename: Ming-Cheng
authors.initials: MC
authors.lastname: Lin
authors.forename: Kuei-Chuan
authors.initials: KC
authors.lastname: Chan
authors.forename: Chung-Yin
authors.initials: CY
authors.lastname: Chen
authors.forename: Der-Jinn
authors.initials: DJ
authors.lastname: Wu
authors.forename: Chung-Sheng
authors.initials: CS
authors.lastname: Lin
authors.forename: Shih-Ann
authors.initials: SA
authors.lastname: Chen
mesh_terms: 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
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D004656:Enalapril; D000638:Amiodarone