title: Combination therapy of renin angiotensin system inhibitors and bepridil is useful for maintaining sinus rhythm in patients with atrial fibrillation.
abstract: BACKGROUND
  The present study evaluated the effect of treatment renin angiotensin system inhibitors (RAS-I) for maintaining sinus rhythm after conversion from persistent atrial fibrillation. As the efficacy of RAS-I in atrial fibrillation is unclear, our study evaluated conversion to and maintenance of sinus rhythm by combination therapy with RAS-I and bepridil in patients in atrial fibrillation.
  
  
  METHODS
  Bepridil was administered to 125 consecutive patients with paroxysmal and persistent atrial fibrillations. Two groups of patients were compared: The bepridil group was treated with bepridil alone, the RAS-I group with bepridil plus angiotensin II receptor blockers or angiotensin converting enzyme inhibitors. The primary end point was length of time to first recurrence of atrial fibrillation.
  
  
  RESULTS
  Maintenance of sinus rhythm was achieved in 25 patients (45%) in the bepridil group and 44 patients (63%) in the RAS-I group (persistent and paroxysmal atrial fibrillations). The difference between the bepridil group and the RAS-I group was significant (p < 0.05). Maintenance of sinus rhythm was achieved in 9 of 25 patients (36%) in the bepridil group, and in 22 of 35 patients (62%) in the RAS-I group with persistent atrial fibrillation. The difference between the bepridil group and the RAS-I group was significant (p < 0.05). Bepridil plus RAS-I was particularly effective at preventing the recurrence of atrial fibrillation in patients with left ventricular dysfunction (left ventricular ejection fraction < 50%).
  
  
  CONCLUSIONS
  Combination therapy with RAS-I and bepridil may be useful for maintenance of sinus rhythm.
authors.affiliation: The Third Department of Internal Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan. mitsu-0709@fiberbit.net
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Kawamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Onuki
authors.forename: Fumito
authors.initials: F
authors.lastname: Miyoshi
authors.forename: Yoshino
authors.initials: Y
authors.lastname: Minoura
authors.forename: Taku
authors.initials: T
authors.lastname: Asano
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanno
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D015764:Bepridil / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D015764:Bepridil