Use of Irbesartan to Maintain Sinus Rhythm in Patients With Long-Lasting Persistent Atrial Fibrillation. A Prospective and Randomized Study. - Use of Irbesartan to Maintain Sinus Rhythm in Patients With Long-Lasting Persistent Atrial Fibrillation. A Prospective and Randomized Study.

Description:

This trial was designed to assess the association between treatment with an angiotensin receptor blocker (ARB) and the probability of recurrent atrial fibrillation (AF) after cardioversion in patients treated with amiodarone.

Study Design

Patients Enrolled: 154

Drug/Procedures Used:

One hundred fifty-four patients with persistent AF for >7 days and a left atrial diameter <6 cm were treated with amiodarone, 400 mg/day for 2 months, then 200 mg/day. The patients were randomly assigned to treatment (79) or no treatment (75) with 150-300 mg/day of irbesartan (an ARB). Transthoracic cardioversion was performed after 3 weeks of drug therapy. The patients were examined 1, 2, 3, and 4 weeks, and 2, 3, 6, and 12 months after cardioversion.

Principal Findings:

The mean age of the patients was 66 years, and their mean left atrial diameter was 4.5 cm. Hypertension was present in 42% of patients, and 21% had lone AF. The AF had been present for a mean of 9 months. At 2 months of follow-up, sinus rhythm was present in 85% of patients who received irbesartan, compared to 63% of those who did not. At 1 year of follow-up, sinus rhythm was still present in 80% of patients who received irbesartan, compared to 56% of those who did not. Compared to treatment with amiodarone by itself, irbesartan reduced the risk of recurrent AF by 65%.

Interpretation:

Among patients with persistent atrial fibrillation for > 7 days, the addition of irbesartan significantly reduces the recurrence rate of AF after cardioversion compared to amiodarone alone. Almost all of irbesartan's beneficial effect was manifest by 2 months of follow-up, suggesting that irbesartan may blunt the early electrical remodeling process that predisposes patients to early recurrences of AF. This possibility is consistent with prior studies demonstrating that atrial remodeling is attenuated by candesartan and captopril and augmented by angiotensin II.

References:

Madrid AH, Bueno MG, Rebollo JMG, 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.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, EP Basic Science, Atrial Fibrillation/Supraventricular Arrhythmias, Novel Agents, Hypertension

Keywords: Follow-Up Studies, Electric Countershock, Tetrazoles, Captopril, Biphenyl Compounds, Recurrence, Angiotensin II Type 1 Receptor Blockers, Benzimidazoles, Atrial Remodeling, Atrial Fibrillation, Hypertension


< Back to Listings