Long-term efficacy of combination therapy using antiarrhythmic agents and angiotensin converting enzyme inhibitor in patients with paroxysmal and persistent atrial fibrillation: importance of the timing of administration

• Published in: Journal of cardiology Vol. 41; no. 2; p. 73
• Main Authors: Komatsu, Takashi, Nakamura, Shin, Suzuki, Osamu, Horiuchi, Daisuke, Owada, Shingen, Kameda, Kunihiko, Tomita, Hirofumi, Oikawa, Koichi, Abe, Naoki, Okumura, Ken
• Format: Journal Article
• Language: Japanese
• Published: Netherlands 01-02-2003
• Subjects: Aged; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Anti-Arrhythmia Agents - administration & dosage; Anti-Arrhythmia Agents - therapeutic use; Atrial Fibrillation - drug therapy; Atrial Fibrillation - prevention & control; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged
• ISSN: 0914-5087

This study examined the long-term efficacy of combination therapy using antiarrhythmic agents and angiotensin converting enzyme inhibitor (ACE-I) to maintain sinus rhythm in patients with paroxysmal and persistent atrial fibrillation (Paf). There were 246 patients (176 men, 70 women, mean age 67.3 +/- 11.7 years, mean follow-up period 48.9 +/- 29.3 months) divided into two groups: the ACE-I(+) group (n = 74) and the ACE-I(-) group (n = 172).
The incidence of hypertension and underlying heart disease in the ACE-I(+) group (85.1% and 34.3%, respectively) was significantly higher than those in the ACE-I(-) group (37.8% and 25.0%, respectively) (both p < 0.01). Left ventricular ejection fraction in the ACE-I(+) group (65.6 +/- 12.5%) was significantly lower than that in the ACE-I(-) group (71.9 +/- 8.9%) (p < 0.01). The actuarial rate of the maintenance of sinus rhythm at 48 months in the ACE-I(+) group (86.5%) was similar to that in the ACE-I(-) group (83.1%). Among the 104 patients who had suffered from Paf for < 3 months after the first episode, the actuarial rate of maintenance of sinus rhythm at 48 months in the ACE-I(+) group (97.1%, n = 35) was significantly higher than that in the ACE-I(-) group (82.6%, n = 65), and the period of maintenance of sinus rhythm in the ACE-I(+) group (54.8 +/- 30.8 months) was significantly longer than that in the ACE-I(-) group (28.4 +/- 20.5 months) (both p < 0.05).
ACE-I must be additionally administered within 3 months of the first Paf episode to maintain normal sinus rhythm in patients with Paf.