title: Central sympathetic inhibition to reduce postablation atrial fibrillation recurrences in hypertensive patients: a randomized, controlled study.
abstract: BACKGROUND
  The autonomic system is an important determinant of atrial arrhythmogenesis. Current evidence indicates that a combined sympathovagal drive is most commonly responsible for eliciting atrial fibrillation (AF) episodes. The purpose of this study was to test whether moxonidine, a centrally acting sympathoinhibitory agent, can lead to a reduction in postablation AF recurrence.
  
  
  RESULTS
  This was a prospective, double-blinded, randomized study of 291 hypertensive patients with symptomatic paroxysmal AF who were scheduled to undergo pulmonary vein isolation. Patients were randomly assigned to receive either moxonidine (0.2-0.4 mg daily) or placebo, along with standard antihypertensive treatment. No significant differences in blood pressure levels were observed between the 2 groups. In the primary outcome analysis, mean recurrence-free survival was 467 days (95% CI, 445-489 days) in the moxonidine group as compared with 409 days (95% CI, 381-437 days) in control subjects (log rank test, P=0.006). The calculated 12-month recurrence rate estimates were 36.9% in the control group and 20.0% in the moxonidine group (P=0.007). Moxonidine treatment was associated with lower recurrence risk after adjustment for age, body mass index, number of AF episodes in the previous year, and left atrial diameter (adjusted hazard ratio, 0.35 [95% CI, 0.22-0.55]; P<0.001).
  
  
  CONCLUSIONS
  Treatment with moxonidine is associated with less AF recurrences after ablation treatment for drug-refractory AF in patients with hypertension. The observed effect does not appear to depend on the antihypertensive action of this agent.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01791699.
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.). ggiann@med.uoa.gr georgios.giannopolous@yale.edu.
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Charalampos
authors.initials: C
authors.lastname: Kossyvakis
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Michael
authors.initials: M
authors.lastname: Efremidis
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Apostolos
authors.initials: A
authors.lastname: Katsivas
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Panagopoulou
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Doudoumis
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raisakis
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Letsas
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Ilias
authors.initials: I
authors.lastname: Rentoukas
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Vlasios
authors.initials: V
authors.lastname: Pyrgakis
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Antonis S
authors.initials: AS
authors.lastname: Manolis
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.affiliation: From the Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece (G.G., C.K., K.D., K.R., I.R., V.P., S.D.); 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece (M.E., K.L.); 1st Department of Cardiology, Red Cross Hospital, Athens, Greece (A.K.); 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece (V.P., A.S.M., D.T., C.S.).
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007093:Imidazoles / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D013564:Sympathetic Nervous System / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D007093:Imidazoles; C043482:moxonidine
keywords: hypertension; moxonidine