on June 24, 2002
Circulation. 2002
Published online before print June 24, 2002, doi: 10.1161/01.CIR.0000022665.18619.83
Published online before print June 24, 2002, doi: 10.1161/01.CIR.0000022665.18619.83
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Submitted on March 15, 2002
From the Arrhythmia Unit, Cardiology Department, Ramon y Cajal Hospital, Department of Medicine, Alcala University, Madrid, Spain. * To whom correspondence should be addressed. E-mail: cmoro{at}hrc.insalud.es.
Background—Data from studies of angiotensin-converting enzyme inhibitors provide evidence that the renin-angiotensin-aldosterone system plays a role as a mediator of atrial remodeling in atrial fibrillation. The present study has evaluated the effect of treatment with the angiotensin I type 1 receptor blocker irbesartan on maintaining sinus rhythm after conversion from persistent atrial fibrillation. Methods and Results—To be included in the present study, patients must have had an episode of persistent atrial fibrillation for >7 days. The patients were then randomized and scheduled for electrical cardioversion. Two groups of patients were compared: Group I was treated with amiodarone, and group II was treated with amiodarone plus irbesartan. The primary end point was the length of time to a first recurrence of atrial fibrillation. From a total of 186 patients assessed in the study, 154 were analyzed with the use of intention-to-treat analysis. Seventy-five patients were randomly allocated to group I and 79 to group II. After 2 months of follow-up in the intention-to-treat analysis, the group treated with irbesartan had fewer patients with recurrent atrial fibrillation (Kaplan-Meier analysis, 84.79% versus 63.16%, P=0.008). The Kaplan-Meier analysis of time to first recurrence during the follow-up period (median time, 254 days [range, 60 to 710]) also showed that patients treated with irbesartan had a greater probability of remaining free of atrial fibrillation (79.52% versus 55.91%, P=0.007). Conclusions—Patients treated with amiodarone plus irbesartan had a lower rate of recurrence of atrial fibrillation than did patients treated with amiodarone alone.
Revised on May 1, 2002
Accepted on May 2, 2002
Use of Irbesartan to Maintain Sinus Rhythm in Patients With Long-Lasting Persistent Atrial Fibrillation. A Prospective and Randomized Study
Antonio H. Madrid MD,
Key words: angiotensin • fibrillation • tachyarrhythmias • cardioversion
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P. M. Kistler, N. C. Davidson, P. Sanders, S. P. Fynn, I. H. Stevenson, S. J. Spence, J. K. Vohra, P. B. Sparks, and J. M. Kalman Absence of acute effects of angiotensin II on atrial electrophysiology in humans J. Am. Coll. Cardiol., January 4, 2005; 45(1): 154 - 156. [Full Text] [PDF]
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L.J. Jordaens and J.M. Mekel Electrical storm in the ICD era Europace, January 1, 2005; 7(2): 181 - 183. [Full Text] [PDF]
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S. G. Williams, D. T. Connelly, M. Jackson, A. Bennett, K. Albouaini, and D. M. Todd Does treatment with ACE inhibitors or angiotensin II receptor antagonists prevent atrial fibrillation after dual chamber pacemaker implantation? Europace, January 1, 2005; 7(6): 554 - 559. [Abstract] [Full Text] [PDF]
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R. Shelton Prevention of atrial fibrillation after cardioversion: results of the PAFAC trial Eur. Heart J., December 1, 2004; 25(23): 2174 - 2174. [Full Text] [PDF]
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C. J Boos Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation Eur. Heart J., October 1, 2004; 25(19): 1761 - 1761. [Full Text] [PDF]
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G. D. Veenhuyzen, C. S. Simpson, and H. Abdollah Atrial fibrillation Can. Med. Assoc. J., September 28, 2004; 171(7): 755 - 760. [Abstract] [Full Text] [PDF]
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A. H Madrid, I. M. Marin, C. Escobar Cervantes, E. Bernal Morell, J. Escudero Estevez, G. Moreno, J. Rondon Parajon, Jian Peng, L. Limon, S. Nannini, et al. Prevention of recurrences in patients with lone atrial fibrillation. The dose-dependent effect of angiotensin II receptor blockers Journal of Renin-Angiotensin-Aldosterone System, September 1, 2004; 5(3): 114 - 120. [Abstract] [PDF]
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W Anne, R Willems, N Van der Merwe, F Van de Werf, H Ector, and H Heidbuchel Atrial fibrillation after radiofrequency ablation of atrial flutter: preventive effect of angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, and diuretics Heart, September 1, 2004; 90(9): 1025 - 1030. [Abstract] [Full Text] [PDF]
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P. L. L'Allier, A. Ducharme, P.-F. Keller, H. Yu, M.-C. Guertin, and J.-C. Tardif Angiotensin-converting enzyme inhibition in hypertensive patients is associated with a reduction in the occurrence of atrial fibrillation J. Am. Coll. Cardiol., July 7, 2004; 44(1): 159 - 164. [Abstract] [Full Text] [PDF]
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A. Boldt, J. Garbade, J. F. Gummert, and S. Dhein Reply J. Am. Coll. Cardiol., June 16, 2004; 43(12): 2363 - 2364. [Full Text] [PDF]
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S. Nattel Defining "Culprit Mechanisms" in Arrhythmogenic Cardiac Remodeling Circ. Res., June 11, 2004; 94(11): 1403 - 1405. [Full Text] [PDF]
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C.-T. Tsai, L.-P. Lai, J.-L. Lin, F.-T. Chiang, J.-J. Hwang, M. D. Ritchie, J. H. Moore, K.-L. Hsu, C.-D. Tseng, C.-S. Liau, et al. Renin-Angiotensin System Gene Polymorphisms and Atrial Fibrillation Circulation, April 6, 2004; 109(13): 1640 - 1646. [Abstract] [Full Text] [PDF]
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R.J. Shelton, G.C. Kaye, and J.G.F. Cleland Controlling persistent atrial fibrillation QJM, March 1, 2004; 97(3): 179 - 180. [Full Text] [PDF]
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K. S. Channer, A. Birchall, R. P. Steeds, S. J. Walters, W. W. Yeo, J. N. West, R. Muthusamy, W. E. Rhoden, B. T. Saeed, P. Batin, et al. A randomized placebo-controlled trial of pre-treatment and short- or long-term maintenance therapy with amiodarone supporting DC cardioversion for persistent atrial fibrillation Eur. Heart J., January 2, 2004; 25(2): 144 - 150. [Abstract] [Full Text] [PDF]
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H. Heidbuchel A paradigm shift in treatment for atrial fibrillation: from electrical to structural therapy? Eur. Heart J., December 1, 2003; 24(23): 2077 - 2078. [Full Text] [PDF]
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