Combination of Irbesartan and Amiodarone to Maintain Sinus Rhythm in Patients With Persistent Atrial Fibrillation After Rheumatic Valve Replacement

Qiang Ji; Yunqing Mei; Xisheng Wang; Jing Feng; Dewei Wusha; Jianzhi Cai; Yifeng Sun; Shiliang Xie

doi:10.1253/circj.cj-10-0254

January 1, 2010Circulation JournalOpen Access

Combination of Irbesartan and Amiodarone to Maintain Sinus Rhythm in Patients With Persistent Atrial Fibrillation After Rheumatic Valve Replacement

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Why the study?

Does the combination of irbesartan and amiodarone reduce the recurrence of atrial fibrillation in patients with persistent atrial fibrillation after rheumatic valve replacement?

Structured PICO

Does the combination of irbesartan and amiodarone reduce the recurrence of atrial fibrillation in patients with persistent atrial fibrillation after rheumatic valve replacement?

P

Population

85 patients with persistent atrial fibrillation after rheumatic valve replacement scheduled for electrical cardioversion

I

Intervention

Irbesartan 150 mg/d plus amiodarone, starting 10 days before scheduled electrical cardioversion

C

Comparator

Amiodarone alone

O

Outcome

Recurrence of atrial fibrillationhard clinical

The addition of irbesartan to amiodarone significantly improves the maintenance of sinus rhythm and AF-free survival after cardioversion in patients with persistent AF following rheumatic valve replacement.

Implication

Supports adding irbesartan to amiodarone for sinus rhythm maintenance after rheumatic valve replacement; extends upstream therapy evidence in valvular AF.

Abstract

BACKGROUND: Atrial fibrillation (AF) after rheumatic valve replacement is the most common arrhythmic complication. Previous studies reported angiotensin-II receptor blocker can prevent AF. This study aimed to assess the effect of a combination of irbesartan and amiodarone on the maintenance of sinus rhythm after cardioversion of AF in patients with post-rheumatic valve replacement in a randomized, controlled trial. METHODS AND RESULTS: Eighty-five consecutive patients undergoing rheumatic valve surgery were enrolled and randomly assigned to an irbesartan plus amiodarone (irbesartan 150 mg/d, n=43) or an amiodarone group (n=42) starting 10 days before scheduled electrical cardioversion. The primary end-point was recurrence of AF. Pharmacological conversion was documented in 7 patients, and electrical conversion in 68 patients (87.2%). A higher rate of maintenance of sinus rhythm (69.8% vs 40.5%, P=0.01) and a better AF-free survival (chi(2)=7.466, P=0.006) were observed in the irbesartan plus amiodarone group compared to the amiodarone group during the 1-year follow-up period. Cox regression showed that use of irbesartan was an independent factor associated with the maintenance of sinus rhythm after cardioversion (OR=0.43, P=0.018), whereas increased left atrium diameter was associated with increased risk (OR=1.54, P=0.005). CONCLUSIONS: In patients with post-rheumatic valve replacement, the combination of amiodarone and irbesartan demonstrated a lower rate of AF recurrence after cardioversion than amiodarone alone, which might be due to preventing the atrial remodeling.