Amiodarone plus RAS inhibitor best for paroxysmal AF: "Amiodarone plus RAS inhibitor best for paroxysmal AF
Adding an inhibitor of the renin-angiotensin system (RAS) to low-dose amiodarone is more effective than amiodarone alone for preventing arrhythmias in patients with paroxysmal atrial fibrillation (AF), study results have shown. Yuehui Yin (Chongqing University of Medical Sciences, China) and colleagues undertook a randomized study involving 177 patients with lone paroxysmal AF. The patients were randomly assigned to receive one of three open-label treatment regimens: (1) amiodarone 600 mg/day decreasing to 200 mg/day; (2) low-dose amiodarone plus losartan 50–100 mg/day; or (3) low-dose amiodarone plus perindopril 2–4 mg/day The primary endpoint, AF incidence between 14 days and 24 months of randomization, was reached by 41% patients in group 1, 19% in group 2, and 24% in group 3, reflecting a statistically significant difference between group 1 and groups 2 and 3. Furthermore, AF recurrence was significantly reduced in groups 2 and 3 versus group 1, although there was no difference in AF recurrence-free survival. Interestingly, left atrial diameter was significantly smaller in groups 2 and 3 than in group 1, the first time such an effect has been demonstrated. Writing in the European Heart Journal, Yin and co-authors say several mechanisms may underlie the beneficial effects of losartan and perindopril observed in their study. The drugs may reverse electrical remodeling caused by AF; they may inhibit AF-induced structural remodeling; or they may cause sympatholytic effects by reducing plasma norepinephrine levels. "The combination of perindopril or losartan with low-dose amiodarone is more effective than low-dose amiodarone alone for the prevention of AF recurrence in patients with lone paroxysmal AF," Yin et al conclude. "Adding losartan or perindopril to amiodarone can inhibit left atrial enlargement in this group of patients."
Eur Heart J 2006; 27: 1841-1846"
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