[Chronic effects on the prevention of atrial fibrillation recurrence in patients with lone paroxysmal atrial fibrillation treated with amiodarone, segmental pulmonary vein ablation, or amiodarone plus losartan: a prospective cohort study].
OBJECTIVE
This study was designed to compare clinical efficacy of segmental pulmonary vein ablation (SPVI), amiodarone or amiodarone plus losartan on sinus rhythm maintenance in patients with lone paroxysmal atrial fibrillation (PAF).


METHODS
Patients with lone PAF were treated with amiodarone alone (A, n = 52), segmental pulmonary vein isolation (SPVI, n = 51), or amiodarone plus losartan (AL, n = 51). The primary endpoint of this study was the incidence of symptomatic atrial tachyarrhythmia (> 30 s) documented by 12 lead ECG or Holter during 12 months follow-up period.


RESULTS
During follow-up, AF was documented in 24 patients (46.2%) in A group, 11 patients (21.6%) in SPVI group and 12 (23.5%) in AL group (P < 0.05 vs. A group). The Kaplan-Meier survival analysis demonstrated a significant equally reduction in AF recurrence in SPVI and AL groups (P = 0.009, log-rank test and P = 0.018, log-rank test, respectively) compared with A group. The hazard ratio for AF recurrence in patients treated with SPVI and amiodarone plus losartan was 0.41 (95% CI 0.200 to 0.848, P = 0.016) and 0.46 (95% CI 0.225 to 0.953, P = 0.036), respectively. Incidences of major adverse cardiac events were similar among the groups (9.6% in A, 3.9% in SPVI and 7.8% in AL group, P > 0.05).


CONCLUSIONS
The results of this study suggest that the segmental pulmonary vein isolation and amiodarone plus losartan are superior to amiodarone alone for preventing AF recurrence in patients with lone PAF.
Ling
Zhi-yu
ZY
Department of Cardiology, Second Affiliated Hospital, Chongqing University of Medical Sciences, Chongqing 400010, China.
Lan
Xian-bin
XB
Su
Li
L
Liu
Zeng-chang
ZC
Wu
Jin-jin
JJ
Liu
Dong
D
Chen
Yun-qing
YQ
Yang
Xiao-yu
XY
She
Qiang
Q
Luo
Kai-liang
KL
Zrenner
Bernhard
B
Yin
Yue-hui
YH
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000517:prevention & control / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D019808:Losartan / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D019808:Losartan; D000638:Amiodarone