Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation: Results of a prospective and controlled study

doi:10.1016/j.ehj.2003.08.014

European Heart Journal 2003 24(23):2090-2098; doi:10.1016/j.ehj.2003.08.014
Copyright © 2003 by the European Society of Cardiology.

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Clinical research

Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation

Results of a prospective and controlled study

Kwo-Chang Ueng^a^,*, Tsung-Po Tsai^a, Wen-Chung Yu^b, Chin-Feng Tsai^a, Ming-Cheng Lin^a, Kuei-Chuan Chan^a, Chung-Yin Chen^b, Der-Jinn Wu^a, Chung-Sheng Lin^a and Shih-Ann Chen^b

^a Division of Cardiology and Cardiovascular Surgery, Institute of Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan
^b National Yang-Ming University, School of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

^* Correspondence to: Kwo-Chang Ueng, MD, Division of Cardiology, Chung-Shan Medical University Hospital, Taichung, 110, Sec. 1, Chien-Kuo N. Rd., Taichung, Taiwan. Tel: 886-4-2253-2603; Fax: 886-4-2252-3626
E-mail address: ueng.kc{at}msa.hinet.net

Received 28 April 2003; revised 22 July 2003; accepted 14 August 2003

Abstract

Aims This study aimed to assess whether enalapril could improvecardioversion outcome and facilitate sinus rhythm maintenanceafter conversion of chronic atrial fibrillation (AF).

Methods and results Patients with chronic AF for more than 3months were assigned to receive either amiodarone (200mg orally3 times a day; group I: n=75) or the same dosage of amiodaroneplus enalapril (10mg twice a day; group II: n=70) 4 weeks beforescheduled external cardioversion. The end-point was the timeto first recurrence of AF. In 125 patients (86.2%), AF was convertedto sinus rhythm. Group II had a trend to a trend to a lowerrate of immediate recurrence of AF than group I did (4.3% vs14.7%, P=0.067). Kaplan–Meier analysis demonstrated ahigher probability of group II remaining in sinus rhythm at4 weeks (84.3% vs 61.3%, P=0.002) and at the median follow-upperiod of 270 days (74.3% vs 57.3%, P=0.021) than in group II.

Conclusion The addition of enalapril to amiodarone decreasedthe rate of immediate and subacute arrhythmia recurrences andfacilitated subsequent long-term maintenance of sinus rhythmafter cardioversion of persistent AF.

Key Words: Atrial fibrillation • Remodelling • Angiotensin-convertingenzyme inhibitor

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