Adalet GÜRLEK, İrem DİNÇER, Timuçin ALTIN, Çağdaş ÖZDÖL, Sibel TURHAN, Mustafa KILIÇKAP, Çetin EROL

Comparison of angiotensin converting enzyme inhibitors and beta blockers in prevention of atrial fibrillation recurrences after electrical cardioversion

Atriyal fibrilasyonun (AF) elektriksel kardiyoversiyonu sonrasında, anjiyotensin dönüştürücü enzim (ACE) inhibitörleri ve beta blokerlerin atriyal yapısal ve elektriksel remodeling' i azaltmak suretiyle AF nükslerini azalttığı gösterilmiştir. Bu çalışmada, kardiyoversiyon sonrasında ACE inhibitörü cilazapril ve beta bloker metoprolol' ün sinüs ritmi idamesindeki etkileri karşılaştırıldı. Çalışmaya persistan AF'si olup başarılı kardiyoversiyon yapılan 120 hasta alındı. Kardiyoversiyon sonrasında hastalar 3 gruba randomize edildi. Grup I' e (n=41) amiodaron, Grup II' ye (n=41) amiodaron+metoprolol, Grup III' e (n=38) amiodaron+cilazapril verildi. Çalışmanın primer sonlanım noktası AF nüks oranları ve AF nüksü görülenlerde nükse kadar geçen zaman idi. Bir yıllık takip sonunda gruplar arasında sinüs ritmi idamesi arasında anlamlı fark saptanmadı (Kaplan Meier analizi, sırasıyla %24, %37 and %26; log rank=0.3). AF nüks zamanları açısından da gruplar arasında fark gözlenmedi. Sonuç olarak, amiodaron, amiodaron+metoprolol veya amiodaron+cilazapril tedavilerinin AF nüksü üzerine etkileri benzer bulunmuştur.

Elektriksel kardiyoversiyon sonrasında atriyal fibrilasyon nükslerinin önlenmesinde anjiyotensin dönüştürücü enzim inhibitörleri ve beta blokerlerin karşılaştırılması

Angiotensin-converting enzyme (ACE) inhibitors and beta blockers were shown to be effective in prevention of atrial fibrillation (AF) recurrences after electrical cardioversion, by interfering with atrial structural and electrical remodeling. In this study, we aimed to compare the effects of ACE inhibitor cilazapril and beta blocker metoprolol after cardioversion of AF in terms of sinus rhythm maintenance. The study population comprised 120 patients with persistent atrial fibrillation (>7 days) who underwent successful cardioversion. Randomization into 3 groups was done after successful cardioversion. Group I (n=41) was treated with amiodarone, group II (n=41) was treated with amiodarone plus metoprolol, and group III (n=38) was treated with amiodarone plus cilazapril. The primary end-point of the study was the recurrence rates between groups at one year and with those who recurred, the time to recurrence of AF. After 1 year follow-up, maintenance of sinus rhythm were similar among groups (Kaplan-Meier analysis, 24%, 37% and 26% respectively; log rank=0.3). There was no difference among groups with respect to time to recurrence of AF. In conclusion, patients treated with amiodarone only, amiodarone plus metoprolol and amiodarone plus cilazapril had similar rates of recurrence of AF.

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