[Comparison of amiodarone plus irbesartan regimen versus amiodarone alone on maintaining sinus rhythm in rheumatic heart disease patients with persistent atrial fibrillation post valve replacement and cardioversion].
OBJECTIVE
To compare the efficacy of combined amiodarone and irbesartan use versus amiodarone alone on maintaining sinus rhythm in rheumatic heart disease patients with persistent atrial fibrillation (AF) post valve replacement and cardioversion.


METHODS
Patients were randomly divided into amiodarone group (A, n = 31) and amiodarone plus irbesartan group (AI, n = 32) and all patients received Warfarin (INR 2.0 - 3.0). For patients in group A, intravenous amiodarone (600 mg/d) was applied for 10 days and oral amiodarone (200 mg, b.i.d.) was given on the 7th day for 3 days. For patients in group AI, irbesartan (150 mg/d) was added on top of amiodarone at the study begin. Electric cardioversion was performed for patients still with AF on day 10. Amiodarone (200 mg, b.i.d. for 1 week, then 200 mg, q.d. till study end) with or without irbesartan (150 mg/d) was continued thereafter. Patients were followed up for 12 months after sinus rhythm recovery. The primary end points are first recurrence of symptomatic and asymptomatic AF.


RESULTS
Twelve months post therapy, number of patients on sinus rhythm was significantly higher (68.7% vs. 41.9%, P<0.05) and left atrium diameter (LAD) was significantly smaller [(48.6 +/- 4.6) mm vs. (51.5 +/- 4.2) mm, P<0.05] in group AI than those in group A. LAD (OR 1.242) and use of irbesartan (OR 0.226) are associated with the AF recurrence.


CONCLUSIONS
Combined amiodarone and irbesartan use is superior to amiodarone alone for maintaining sinus rhythm in rheumatic heart disease patients with persistent AF post valve replacement and cardioversion.
Ding
Ping
P
Department of Cardio-Surgery, Changhai Hospital of the Second Army Medical University, Shanghai 200433, China.
Li
Li
L
Zhang
Hao
H
Chen
Liang-jin
LJ
Deng
Xue-jun
XJ
Yuan
Yi-qiang
YQ
D000328:Adult; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001713:Biphenyl Compounds / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000077405:Irbesartan; D008297:Male; D008875:Middle Aged; D012214:Rheumatic Heart Disease / Q000188:drug therapy; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan; D000638:Amiodarone