Combination of irbesartan and amiodarone to maintain sinus rhythm in patients with persistent atrial fibrillation after rheumatic valve replacement.
BACKGROUND
Atrial fibrillation (AF) after rheumatic valve replacement is the most common arrhythmic complication. Previous studies reported angiotensin-II receptor blocker can prevent AF. This study aimed to assess the effect of a combination of irbesartan and amiodarone on the maintenance of sinus rhythm after cardioversion of AF in patients with post-rheumatic valve replacement in a randomized, controlled trial.


RESULTS
Eighty-five consecutive patients undergoing rheumatic valve surgery were enrolled and randomly assigned to an irbesartan plus amiodarone (irbesartan 150 mg/d, n=43) or an amiodarone group (n=42) starting 10 days before scheduled electrical cardioversion. The primary end-point was recurrence of AF. Pharmacological conversion was documented in 7 patients, and electrical conversion in 68 patients (87.2%). A higher rate of maintenance of sinus rhythm (69.8% vs 40.5%, P=0.01) and a better AF-free survival (chi(2)=7.466, P=0.006) were observed in the irbesartan plus amiodarone group compared to the amiodarone group during the 1-year follow-up period. Cox regression showed that use of irbesartan was an independent factor associated with the maintenance of sinus rhythm after cardioversion (OR=0.43, P=0.018), whereas increased left atrium diameter was associated with increased risk (OR=1.54, P=0.005).


CONCLUSIONS
In patients with post-rheumatic valve replacement, the combination of amiodarone and irbesartan demonstrated a lower rate of AF recurrence after cardioversion than amiodarone alone, which might be due to preventing the atrial remodeling.
Ji
Qiang
Q
Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University Medical School, Shanghai, P.R. China.
Mei
Yunqing
Y
Wang
Xisheng
X
Feng
Jing
J
Wusha
Dewei
D
Cai
Jianzhi
J
Sun
Yifeng
Y
Xie
Shiliang
S
D000328:Adult; D000638:Amiodarone / Q000008:administration & dosage*; D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control; D001713:Biphenyl Compounds / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006325:Heart Atria / Q000473:pathology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D000077405:Irbesartan; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012216:Rheumatic Diseases; D013777:Tetrazoles / Q000008:administration & dosage*; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan; D000638:Amiodarone