title: Combination of irbesartan and amiodarone to maintain sinus rhythm in patients with persistent atrial fibrillation after rheumatic valve replacement.
abstract: 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.
authors.affiliation: Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University Medical School, Shanghai, P.R. China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ji
authors.forename: Yunqing
authors.initials: Y
authors.lastname: Mei
authors.forename: Xisheng
authors.initials: X
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Feng
authors.forename: Dewei
authors.initials: D
authors.lastname: Wusha
authors.forename: Jianzhi
authors.initials: J
authors.lastname: Cai
authors.forename: Yifeng
authors.initials: Y
authors.lastname: Sun
authors.forename: Shiliang
authors.initials: S
authors.lastname: Xie
mesh_terms: 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
chemical_list: D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan; D000638:Amiodarone