Use of Irbesartan to Maintain Sinus Rhythm in Patients With Long-Lasting Persistent Atrial Fibrillation: A Prospective and Randomized Study
Abstract
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.
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ACE inhibitors or ARBs may reduce recurrent AF after cardioversion when coadministered with antiarrhythmic drug therapy compared with an antiarrhythmic drug alone.
“ACE inhibitors or ARBs may reduce recurrent AF after cardioversion when coadministered with antiarrhythmic drug therapy compared with an antiarrhythmic drug alone.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [248]
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- Authors
- Madrid, A. H., Bueno, M. G., Rebollo, J. M. G., Marín, I., Peña, G., Bernal, E., Rodriguez, A., Cano, L., Cano, J. M., Cabeza, P., & Moro, C.
- Affiliations
- From the Arrhythmia Unit, Cardiology Department, Ramon y Cajal Hospital, Department of Medicine, Alcala University, Madrid, Spain.
- Hospital Universitario Ramón y Cajal (ES)
- Venue
- Circulation
- Published
- 2002-07-16
- Volume
- 106
- Issue
- 3
- Pages
- 331-336
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2614763070
- Cited by
- 685
- References
- 21
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 6 · 2022: 8 · 2021: 5 · 2020: 8 · 2019: 6 · 2018: 7 · 2017: 3 · 2016: 14 · 2015: 8 · 2014: 13 · 2013: 21 · 2012: 18
- FWCI
- 37.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- irbesartan, persistent atrial fibrillation, sinus rhythm maintenance, amiodarone, renin-angiotensin-aldosterone system, atrial remodeling, electrical cardioversion, atrial fibrillation recurrence, combination therapy
- MeSH terms
- Irbesartan, Adult, Aged, Amiodarone, Angiotensin-Converting Enzyme Inhibitors, Anti-Arrhythmia Agents, Atrial Fibrillation, Biphenyl Compounds, Chronic Disease, Electric Countershock, Female, Follow-Up Studies, Humans, Kinetics, Male, Middle Aged, Periodicity, Recurrence, Tetrazoles, Receptor, Angiotensin, Type 1, Angiotensin Receptor Antagonists
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