Abstract 3696: A Prospective Randomized Study Comparing Amiodarone Versus Amiodarone Plus Losartan Versus Amiodarone Plus Perindopril for the Prevention of Atrial Fibrillation Recurrence in Patients With Lone Paroxysmal Atrial Fibrillation
Background The renin-angiotensin-aldosterone system plays an important role as a mediator of atrial remodelling in atrial fibrillation (AF). This prospective, randomized study sought to test the hypothesis that adding an angiotension II receptor blocker losartan or an angiotension-converting enzyme inhibitor perindopril to low-dose amiodarone reduces AF recurrence in patients with lone paroxysmal AF.
Methods One hundred and seventy-seven patients with lone paroxysmal AF were randomly assigned to three treatment groups: group 1 (n = 59) received amiodarone 200 mg daily alone, group 2 (n = 59) received amiodarone 200 mg daily plus losartan 100 mg daily, and group 3 (n = 59) received amiodarone 200 mg daily plus perindopril 4 mg daily. Follow-up clinical evaluations were conducted every 15 days within the first three months after randomization and at 3-month intervals thereafter up to 24 months. The primary end point was the incidence of AF documented by 12-lead ECG or Holter after 14 days and within 24 months after randomization.
Results The primary end point was reached in 24 patients (41%) in group 1, 11 (19%) in group 2, and 14 (24%) in group 3 (P = 0.02). The Kaplan-Meier survival analysis demonstrated a significant reduction in AF recurrence in group 2 (P = 0.006, log-rank test) as well as in group 3 (P = 0.04, log-rank test) as compared to group 1. No difference in the AF recurrence-free survival was found between group 2 and group 3. After 24 months follow-up, the left atrial diameter in group 2 and group 3 was significantly smaller than that in group 1 (36 ± 2.3 mm and 35 ± 2.4 mm vs. 38 ± 2.4 mm, P < 0.001 for both comparisons).
Conclusions The results of this study demonstrate that the combination of losartan or perindopril with low-dose amiodarone is more effective than low-dose amiodarone alone for the prevention of AF recurrence in patients with lone paroxysmal AF. Adding losartan or perindopril to amiodarone can inhibit left atrial enlargement in this group of patients.