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Prevention of recurrences in patients with lone atrial fibrillation. The dose-dependent effect of angiotensin II receptor blockers

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

Journal of Renin-Angiotensin-Aldosterone System, Vol. 5, No. 3, 114-120 (2004)
DOI: 10.3317/jraas.2004.027


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