Combination of Irbesartan and Amiodarone to Maintain Sinus Rhythm in Patients With Persistent Atrial Fibrillation After Rheumatic Valve Replacement
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概要
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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 (χ2=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.
著者
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Ji Qiang
Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University
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Mei Yunqing
Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University
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Wang Xisheng
Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University
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Feng Jing
Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University
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Sun Yifeng
Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University
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Wusha Dewei
Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University Medical School
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Cai Jianzhi
Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University Medical School
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Xie Shiliang
Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University Medical School
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