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Prevention of recurrences in patients with lone atrial fibrillation. The dose-dependent effect of angiotensin II receptor blockers
Antonio H Madrid
Arrhythmia Unit, Ramón y Cajal Hospital, Department of Medicine, Alcalá University, Madrid, Spain
Irene Marín Marín
Arrhythmia Unit, Ramón y Cajal Hospital, Department of Medicine, Alcalá University, Madrid, Spain
Carlos Escobar Cervantes
Arrhythmia Unit, Ramón y Cajal Hospital, Department of Medicine, Alcalá University, Madrid, Spain
Enrique Bernal Morell
Arrhythmia Unit, Ramón y Cajal Hospital, Department of Medicine, Alcalá University, Madrid, Spain
Jaime Escudero Estévez
Arrhythmia Unit, Ramón y Cajal Hospital, Department of Medicine, Alcalá University, Madrid, Spain
Gerardo Moreno
Arrhythmia Unit, Ramón y Cajal Hospital, Department of Medicine, Alcalá University, Madrid, Spain
Jorge Rondón Parajón
Arrhythmia Unit, Ramón y Cajal Hospital, Department of Medicine, Alcalá University, Madrid, Spain
Jian Peng
Arrhythmia Unit, Ramón y Cajal Hospital, Department of Medicine, Alcalá University, Madrid, Spain
Lilianna Limón
Arrhythmia Unit, Ramón y Cajal Hospital, Department of Medicine, Alcalá University, Madrid, Spain
Sebastian Nannini
Arrhythmia Unit, Ramón y Cajal Hospital, Department of Medicine, Alcalá University, Madrid, Spain
Concepción Moro
Arrhythmia Unit, Ramón y Cajal Hospital, Department of Medicine, Alcalá University, Madrid, Spain, cmoro.hrc{at}salud.madrid.org
Background
Atrial fibrillation (AF) leads to the activation of the renin-angiotensin system (RAS), which seems to play an important role in atrial remodelling. It is not known yet whether RAS blockade may prevent recurrences in patients with lone AF.
Methods and results
Patients with an episode of persistent AF for >7 days, in the absence of cardiac or extracardiac causes and with normal blood pressure values (`lone AF'), were recruited. Ninety patients were randomised and scheduled for electrical cardioversion. Three groups of patients were compared: Group I was treated with amiodarone 400 mg daily (30 patients), group II was treated with amiodarone 400 mg daily plus irbesartan 150 mg daily (30 patients) and group III with amiodarone 400 mg daily plus irbesartan 300 mg daily (30 patients). The primary endpoint was the time to a first recurrence of AF. The patients were cardioverted and followed. The Kaplan-Meier analysis of time to first recurrence during the follow-up period showed that patients treated with amiodarone 400 mg plus irbesartan 300 mg had a greater probability of remaining free of AF (77% vs. 52% for amiodarone and 65% for amiodarone+irbesartan 150 mg), hazard 0.27—0.82; p=0.001). ratio for a recurrence in group III: 0.47 (95% CI
Conclusions
The combination of irbesartan plus amiodarone decreased the rate of AF recurrences, with a dose-dependent effect, in lone AF patients.
Key Words: angiotensin • fibrillation • tachyarrhythmias • cardioversion
References
- Madrid AH, Bueno MG, Rebollo JM et al. Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation. A prospective and randomized study. Circulation 2002;106:331-6.[Abstract/Free Full Text]
- Nakashima H., Kumagai K., Urata H. et al. Angiotensin II antagonist prevents electrical remodeling in atrial fibrillation. Circulation 2000;101:2612-17.[Abstract/Free Full Text]
- Pedersen OD, Bagger H., Køber L. et al. Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 1999;100:376-80.[Abstract/Free Full Text]
- Vermes E.,Tardif J.,Bourassa M. et al. Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction. Insight from the studies of left ventricular dysfunction (SOLVD) trials. Circulation 2003;107:2926-31.[Abstract/Free Full Text]
- Chen Y., Chen Y., Chan P. et al. Angiotensin II increases the arrhythmogenic activity of pulmonary vein cardiomyocyte. PACE 2003;26:632.[Medline]
[Order article via Infotrieve]
- Belluzzi F., Sernesi L., Valenti C. et al. Angiotensin-converting enzyme inhibition with trandolapril prevents recurrence of paroxysmal lone atrial fibrillation in normotensive patients. Eur Heart J 2003;24:2162.
- Kumagai K., Nakashima H., Urata H. et al. Effects of angiotensin II type I receptor antagonist on electrical and structural remodelling in atrial fibrillation. J Am Coll Cardiol 2003;41:2197-204.[Abstract/Free Full Text]
- Everett TH, Li H., Mangrum JM et al. Electrical, morphological, and ultrastructural remodelling and reverse remodelling in a canine model of chronic atrial fibrillation. Circulation 2000;102:1454-60.[Abstract/Free Full Text]
- Allessie MA Atrial electrophysiological remodeling: another vicious circle? J Cardiovasc Electrophysiol 1998;9: 1378-93.[Web of Science][Medline]
[Order article via Infotrieve]
- López B., Querejeta R., Varo N. et al. Usefulness of serum carboxy-terminal propeptide of procollagen type I in assessment of the cardioreparative ability of antihypertensive treatment in hypertensive patients. Circulation 2001;104:286-91.[Abstract/Free Full Text]
- Parving HH, Lehnert H., Brochner-Mortensen J. et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 Diabetes. N Engl J Med 2001;345: 870-8.[Abstract/Free Full Text]
- Wyse DG, Waldo AL, DiMarco JP et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825-33.[Abstract/Free Full Text]
- Van Gelder IC, Hagens VE, Bosker HA et al.A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002;347:1834-40.[Abstract/Free Full Text]
- Kwo-Chang U., Tsung Po T., Wen-Chung Y. et al. Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation. Eur Heart J 2003;24:2090-8.[Abstract/Free Full Text]
- Heidbüchel H.A paradigm shift in treatment for atrial fibrillation: from electrical to structural therapy? Eur Heart J 2003;24:2077-8.[Free Full Text]
- MadridAH, Escobar C., Rebollo JM et al.Angiotensin receptor blocker as adjunctive therapy for rhythm control in atrial fibrillation: results of the irbesartan - amiodarone trial. Card Electrophysiol Rev 2003;7:243-6.[CrossRef][Medline]
[Order article via Infotrieve]
- Ihara M., Urata H., Shirai K. et al. High cardiac angiotensin-II-forming activity in infarcted and non-infarcted human myocardium. Cardiology 2000;94:247-53.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Verdecchia P., Reboldi G., Gattobigio R. et al.Atrial fibrillation in hypertension; predictors and outcome. Hypertension 2003;41:218-23.[Abstract/Free Full Text]
- Healey JS, Connolly SJ Atrial fibrillation: hypertension as a causative agent, risk factor for complications, and potential therapeutic target. Am J Cardiol 2003;91(10A):9G-14G.[Web of Science][Medline]
[Order article via Infotrieve]
- Dorian P., Mangat I. Restoring sinus rhythm in atrial fibrillation.A pyrrhic victory? J Am Coll Cardiol 2003;42:30-2.[Free Full Text]
- Klein H., Goette A. Blockade of atrial angiotensin II type 1 receptors.A novel antiarrhythmic strategy to prevent atrial fibrillation.JAm Coll Cardiol 2003;41:2205-06.[Free Full Text]
- Li D., Fareh S., LeungTK et al. Promotion of atrial fibrillation by heart failure in dogs: atrial remodelling of a different sort. Circulation 1999;100:87-95.[Abstract/Free Full Text]
- Malmquist K., Ohman KP, Lind L. et al. Long-term effects of irbesartan and atenolol on the renin-angiotensin-aldosterone system in human primary hypertension: the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol. J Cardiovasc Pharmacol 2003;42:719-26.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Caballero R., Delpón E., Valenzuela C. et al. Losartan and its metabolite E3174 modify cardiac delayed rectifier K+ currents. Circulation 2002;101:1199-205.
- Moreno I., Caballero R., Gonzalez T. et al. Effects of irbesartan on cloned potassium channels involved in human cardiac repolarization. J Pharmacol Exp Ther 2003;304:862-73.[Abstract/Free Full Text]
- Haissaguerre M., Jais P., Shah DC et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-66.[Abstract/Free Full Text]
- Wijffels M., Crijms H. Recent advances in drug therapy for atrial fibrillation. J Cardiovasc Electrophysiol 2003;14:540-47.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Tamargo J., Caballero R., Delpón E. Pharmacological approaches in the treatment of atrial fibrillation. Curr Med Chem 2004;11:13-28.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
Journal of Renin-Angiotensin-Aldosterone System, Vol. 5, No. 3,
114-120 (2004)
DOI: 10.3317/jraas.2004.027
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