Madrid Antonio H, Marín Irene Marín, Cervantes Carlos Escobar, Morell Enrique Bernal, Estévez Jaime Escudero, Moreno Gerardo, Parajón Jorge Rondón, Peng Jian, Limón Lilianna, Nannini Sebastian, Moro Concepción
Arrythmia Unit, Rámon y Cajal Hospital, Department of Medicine, Madrid 28034, Spain.
J Renin Angiotensin Aldosterone Syst. 2004 Sep;5(3):114-20. doi: 10.3317/jraas.2004.027.
Atrial fibrillation (AF) leads to the activation of the renin-angiotensin system (RAS), which seems to play an important role in atrial remodelling. It is not known yet whether RAS blockade may prevent recurrences in patients with lone AF.
Patients with an episode of persistent AF for >7 days, in the absence of cardiac or extracardiac causes and with normal blood pressure values (lone AF), were recruited. Ninety patients were randomised and scheduled for electrical cardioversion. Three groups of patients were compared: Group I was treated with amiodarone 400 mg daily (30 patients), group II was treated with amiodarone 400 mg daily plus irbesartan 150 mg daily (30 patients) and group III with amiodarone 400 mg daily plus irbesartan 300 mg daily (30 patients). The primary endpoint was the time to a first recurrence of AF. The patients were cardioverted and followed. The Kaplan-Meier analysis of time to first recurrence during the follow-up period showed that patients treated with amiodarone 400 mg plus irbesartan 300 mg had a greater probability of remaining free of AF (77% vs. 52% for amiodarone and 65% for amiodarone+irbesartan 150 mg), hazard ratio for a recurrence in group III: 0.47 (95% CI 0.27-0.82; p=0.001).
The combination of irbesartan plus amiodarone decreased the rate of AF recurrences, with a dose-dependent effect, in lone AF patients.
心房颤动（AF）会导致肾素-血管紧张素系统（RAS）激活，这似乎在心房重构中起重要作用。目前尚不清楚RAS阻断是否能预防孤立性AF患者复发。
招募持续性AF发作超过7天、无心脏或心外病因且血压值正常（孤立性AF）的患者。90例患者被随机分组并安排进行电复律。比较三组患者：第一组每天服用400mg胺碘酮（30例患者），第二组每天服用400mg胺碘酮加150mg厄贝沙坦（30例患者），第三组每天服用400mg胺碘酮加300mg厄贝沙坦（30例患者）。主要终点是AF首次复发的时间。对患者进行复律并随访。随访期间首次复发时间的Kaplan-Meier分析显示，服用400mg胺碘酮加300mg厄贝沙坦的患者无AF复发的概率更高（胺碘酮组为52%，胺碘酮加150mg厄贝沙坦组为65%，胺碘酮加300mg厄贝沙坦组为77%），第三组复发的风险比为0.47（95%CI 0.27-0.82；p=0.001）。
在孤立性AF患者中，厄贝沙坦加胺碘酮联合使用可降低AF复发率，且有剂量依赖性效应。
