A Beneficial Effect of Angiotensin II Receptor Blocker on the Treatment of Persistent Atrial Fibrillation Appears About One Year Later

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Background: Recent trials such as the GISSI-AF suggested that treatment with angiotensin II receptor blockers (ARBs) were not associated with the prevention of recurrent atrial fibrillation (AF). But follow up of these trials were one year only. This study evaluated the effect of ARB in patients with persistent AF refractory to antiarrythmic drugs, during one year or more. Method: In this study, Olmesartan (9.6±7.1 mg) was initiated in 16 patients (10 males, 70±10 years) in whom AF was occurred repeatedly under treatment with Bepridil (159±32 mg, 23±20 months). They were divided into two groups. Group-1 (N=7) included patients in whom AF recurred similarly or progressed to chronic AF after addition of Olmesartan. Group-2 (N=9) included patients in whom AF did not recurred in the course of follow up. We compared changes in echocardiographic parameters and (mean follow-up 28.0±4.2 months). Results: ΔLeft atrial dimension was 4.8±2.4 mm in Group-1, and −0.2±4.8 mm in Group-2 (p<0.05). In Group-2, patients took 11.2±2.7 months to achieve no recurrence from addition of Olmesartan. However, change of systolic blood pressure was −6.8±4.2 mmHg Group-1, and −9.1±7.8 mmHg Group-2 (P=NS). Conclusion: In persistent AF, Olmesartan may have a beneficial effect on the prevention of recurrence through the suppression of atrial structural remodeling, and it seems to take about one year before this effect appears.
日本不整脈学会の論文