Candesartan in the prevention of relapsing atrial fibrillation.
BACKGROUND
Several studies have indicated that treatment with angiotensin converting enzyme (ACE) inhibitors and angiotensin II type 1 receptor blockers (ARBs) may reduce the incidence of atrial fibrillation (AF) in hypertensive patients and patients with left ventricular dysfunction. However, there is limited data on the effect of ACE-inhibitors and ARBs in patients undergoing electrical cardioversion for persistent AF. We hypothesized that treatment with the ARB candesartan, without adjunct antiarrhythmic therapy, would reduce the recurrence rate of AF after successful cardioversion.


METHODS
In a double blind, placebo-controlled study, 171 patients with persistent AF were randomized to receive candesartan 8 mg once daily (n=86) or placebo (n=85) for 3-6 weeks before and candesartan 16 mg once daily or placebo for 6 months after electrical cardioversion. Primary endpoint was recurrence of AF.


RESULTS
A total of 68 patients in the candesartan group and 69 patients in the placebo group were successfully cardioverted. Forty-eight patients (71%) in the candesartan group and 45 (65%) in the placebo group had a recurrence of AF during 6 months follow-up. Median time to recurrence was 8 and 9 days in the candesartan and placebo groups, respectively. The differences between the groups were not statistically significant.


CONCLUSIONS
Treatment with the ARB candesartan for 3-6 weeks before and 6 months after electrical cardioversion had no effect on the recurrence rate of AF.
Tveit
Arnljot
A
Department of Internal Medicine, Asker and Baerum Hospital, 1309 Rud, Norway. arnljot.tveit@broadpark.no
Grundvold
Irene
I
Olufsen
Mona
M
Seljeflot
Ingebjørg
I
Abdelnoor
Michael
M
Arnesen
Harald
H
Smith
Pal
P
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D013777:Tetrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan