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

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 (Circ J 2010, 74: 1873-1879)