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.
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).
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.