Madrid Antonio H, Bueno Manuel G, Rebollo Jose M G, Marín Irene, Peña Gonzalo, Bernal Enrique, Rodriguez Aníbal, Cano Lucas, Cano José M, Cabeza Pedro, Moro Concepción
Arrhythmia Unit, Cardiology Department, Ramon y Cajal Hospital, Department of Medicine, Alcala University, Madrid, Spain.
Circulation. 2002 Jul 16;106(3):331-6. doi: 10.1161/01.cir.0000022665.18619.83.
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.
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).
Patients treated with amiodarone plus irbesartan had a lower rate of recurrence of atrial fibrillation than did patients treated with amiodarone alone.
血管紧张素转换酶抑制剂的研究数据表明，肾素-血管紧张素-醛固酮系统在心房颤动的心房重构中起介导作用。本研究评估了血管紧张素I 1型受体阻滞剂厄贝沙坦在持续性心房颤动转复后维持窦性心律的疗效。
纳入本研究的患者必须有持续时间超过7天的持续性心房颤动发作。然后将患者随机分组并安排进行电复律。比较两组患者：I组接受胺碘酮治疗，II组接受胺碘酮加厄贝沙坦治疗。主要终点是心房颤动首次复发的时间长度。在该研究评估的总共186例患者中，154例采用意向性分析进行分析。75例患者被随机分配到I组，79例被分配到II组。在意向性分析随访2个月后，接受厄贝沙坦治疗的组中复发性心房颤动患者较少（Kaplan-Meier分析，84.79%对63.16%，P=0.008）。随访期间首次复发时间的Kaplan-Meier分析（中位时间，254天[范围，60至710天]）也显示，接受厄贝沙坦治疗的患者保持无房颤的概率更高（79.52%对55.91%，P=0.007）。
与单独接受胺碘酮治疗的患者相比，接受胺碘酮加厄贝沙坦治疗的患者心房颤动复发率更低。
