[Effectiveness of angiotensin-converting enzyme inhibitors in the maintenance of sinus rythm after conversion of arterial fibrillation]

Abstract

This study aimed to prove that angiotensin-converting enzyme inhibitors (ACEI) could improve sinus rhythm maintenance after electrical or chemical conversion of atrial fibrillation (AF).

Methods: A prospective study of 36 patients with lone AF which undertook chemical or electrical conversion was conducted. Group 1 included 20 patients treated exclusively with a class I C antiarrhythmic (Propafenone, 450 mg daily) and group 2 included 16 patients treated with antiarrhythmic plus ACEI pre- and after cardioversion.

Results: These two groups were comparable, with mean age 56.2 +/- 11.8 vs. 57.7 +/- 6.1 years (P 0.709), onset of AF 2.47 +/- 3.72 vs. 5.5 +/- 7.37 months (P 0.205) and echocardiographic parameters: left atrium diameter 45.1 +/- 5.8 vs. 45.0 +/- 6.1 mm (P 0.995); LVTDV 48.5 +/- 5.0 vs. 48.6 +/- 6.4 mm (P 0.998); LVTSV 35.1 +/- 5.0 vs. 36.0 +/- 7.0 mm (P 0.737) and EF 59.0 +/- 6.9% vs. 54.8 +/- 6.1% (P 0.135). The patients were followed up clinically and electrocardiographically 12 months after conversion. Kaplan-Meier analysis showed a higher probability of remaining in sinus rhythm one year after cardioversion for group 2 compared to group 1 (37.5% vs. 20%). The mean time interval for the appearance of recurrences was significantly higher in patients treated with ACEI and antiarrhythmics compared to the patients treated only with antiarrhythmics (7.06 +/- 1.02 vs. 4.50 +/- 0.93 months; Breslow test (generalized Wilcoxon)--4.473, P 0.034).

Conclusion: The addition of ACEI to an antiarrhythmic decreases the rate of AF recurrences and facilitates the maintenance of sinus rhythm after cardioversion.