Abstract 4633: Pretreatment with Mineralcorticoid Receptor Antagonists Plus Beta Blockers and Angiotensin Converting Enzyme Inhibitors Increases the Proportion of Patients in Sinus Rhythm after Electrical Cardioversion for Persistent Atrial Fibrillation and Heart Failure
Aim of this study was to assess the effect on sinus rhythm maintenance after electrical cardioversion of pre-treatment with mineralcorticoid receptor antagonist (MRA) added to beta blockers (BB) and angiotensin-converting enzyme inhibitors (ACEI) in patients with heart failure and persistent atrial fibrillation. We studied 168 consecutive patients with left ventricular dysfunction and persistent atrial fibrillation (AF) who underwent electrical cardioversion (ECV) in our Day Hospital.Group 1 (83 pts) was pretreated with MRA plus BB and ACEI and group 2 (85 pts) with only BB and ACEI. Mean age was 74.4 years in group 1 and 73.9 years in group 2; male gender was 70% in group 1 and 72% in group 2 ; estimated onset of arrhythmia was 5 + −2 months in two groups; ischemic heart disease was present in 55% of group 1 and 61% in group 2 .Hypertension was present in 70% of group 1 and 61% in group 2. Echocardio-graphic parameters of left atrial diameter were not statistically different in two groups:44 mm versus 47 mm ; ejection fraction was 46% (group 1) and 44% (group 2).All patients received warfarin during the 1 year follow up. Aldosterone antagonists ( plus BB and ACEI ) was continued in group 1 after ECV. Group 2 received treatment with BB and ACEI. 4 pts in group 1 and 6 pts in group 2 showed early re-initiation of AF after cardioversion and a second ECV was successfully repeated. At 1 year follow up 67% of pts of group 1 remained in sinus rhythm compared with 42% of pts not treated with aldosterone antagonists. The results in our investigation regarding the proportion of pts in sinus rhythm after ECV favour this treatment strategy for patients with persistent AF and heart failure. A possible mechanism of this result is that aldosterone too stimulates collagen production leading to atrial fibrosis. Remodeling process in heart failure can be better antagonized by combined treatment of Beta blockers, Angiotensin Converting-Enzyme inhibitors and Mineralcorticoid receptors Antagonists.