European Heart Journal Advance Access originally published online on August 4, 2006
European Heart Journal 2006 27(17):2062-2068; doi:10.1093/eurheartj/ehl190
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Pre-treatment with Irbesartan attenuates left atrial stunning after electrical cardioversion of atrial fibrillation
1 First Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
2 Second University Cardiology Department, Attikon University Hospital, University of Athens, Rimini 1, Haidari 12462, Athens, Greece
Received 8 November 2005; revised 19 May 2006; accepted 26 May 2006; online publish-ahead-of-print 4 August 2006.
* Corresponding author. Tel: +30 2105832350; fax: +30 2105832351. E-mail address: nikolaosdagres{at}yahoo.de
See page 2034 for the editorial comment on this article (doi:10.1093/eurheartj/ehl019)
Aims Left atrial (LA) stunning, the transient impairment of LA function, is responsible for an increased thrombo-embolic risk after cardioversion of atrial fibrillation (AF). Angiotensin receptor blockers (ARBs) attenuate atrial remodelling in AF and could theoretically influence LA stunning. We studied the effect of Irbesartan on LA stunning.
Methods and results We prospectively assigned 50 patients from the outpatient clinic undergoing electrical cardioversion for AF with duration of >4 weeks, into two matched groups: 25 patients were treated with Irbesartan (228±93 mg/day) for at least 2 weeks prior to cardioversion (Irbesartan group); 25 patients did not receive ARBs (control group). The groups did not differ concerning age (64±13 vs. 63±13 years, respectively), AF duration (20±18 vs. 20±19 weeks), underlying disease, LA diameter (46±7 vs. 47±9 mm), left ventricular dimensions, and ejection fraction (47.7±11.6 vs. 49.7±14.5%).
We assessed LA appendage emptying velocities (LAAEV) and LA spontaneous echo contrast (LASEC) by transoesophageal echocardiography before and after cardioversion and at 2 weeks, and the A-wave by transthoracic echocardiography after cardioversion, at 2 and at 4 weeks.
LA stunning was significantly attenuated in the Irbesartan group. The reduction of LAAEV immediately after cardioversion was significantly less in the Irbesartan group (LAAEV reduction of 9±49% from 28±9 cm/s before cardioversion to 25±13 cm/s immediately afterwards) than in the control group (reduction of 48±20% from 34±15 cm/s before cardioversion to 16±6 cm/s afterwards) (P=0.048). New or increased LASEC occurred in eight patients (32%) in the Irbesartan vs. 16 patients (64%) in the control group (P=0.046).
Conclusion Irbesartan significantly attenuates LA stunning after electrical cardioversion of AF. Therefore, ARBs may represent an important pharmacological supplementation in patients being prepared for cardioversion.
Key Words: Atrial stunning • Atrial fibrillation • Electrical cardioversion • Angiotensin receptor blockers
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EHJ 2006 27: 2034-2035.[Extract] [FREE Full Text]
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  A. Goette and U. Schotten Inhibition of angiotensin II type 1 receptors reduces atrial stunning and spontaneous echo contrast after electrical cardioversion of atrial fibrillation Eur. Heart J., September 1, 2006; 27(17): 2034 - 2035. [Full Text] [PDF]
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