European Heart Journal Advance Access published online on August 4, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl190
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1 First Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece; Second University Cardiology Department, Attikon University Hospital, University of Athens, Rimini 1, Haidari 12462, Athens, Greece
* To whom correspondence should be addressed. 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.
Received November 8, 2005
Revised May 19, 2006
Accepted May 26, 2006
Clinical research
Pre-treatment with Irbesartan attenuates left atrial stunning after electrical cardioversion of atrial fibrillation
Nikolaos Dagres 1 *, George Karatasakis 2, Fotios Panou 3, Georgios Athanassopoulos 2, Themistoclis Maounis 2, Elias Tsougos 3, Kallirrhoe Kourea 3, Ioannis Malakos 2, Dimitrios Th. Kremastinos 3, and Dennis V. Cokkinos 2
2 First Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
3 Second University Cardiology Department, Attikon University Hospital, University of Athens, Rimini 1, Haidari 12462, Athens, Greece
Nikolaos Dagres, E-mail: nikolaosdagres{at}yahoo.de
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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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