Combination therapy of renin angiotensin system inhibitors and bepridil is useful for maintaining sinus rhythm in patients with atrial fibrillation.

ABSTRACT

BACKGROUND: The present study evaluated the effect of treatment renin angiotensin system inhibitors (RAS-I) for maintaining sinus rhythm after conversion from persistent atrial fibrillation. As the efficacy of RAS-I in atrial fibrillation is unclear, our study evaluated conversion to and maintenance of sinus rhythm by combination therapy with RAS-I and bepridil in patients in atrial fibrillation. METHODS: Bepridil was administered to 125 consecutive patients with paroxysmal and persistent atrial fibrillations. Two groups of patients were compared The bepridil group was treated with bepridil alone, the RAS-I group with bepridil plus angiotensin II receptor blockers or angiotensin converting enzyme inhibitors. The primary end point was length of time to first recurrence of atrial fibrillation. RESULTS: Maintenance of sinus rhythm was achieved in 25 patients (45%) in the bepridil group and 44 patients (63%) in the RAS-I group (persistent and paroxysmal atrial fibrillations). The difference between the bepridil group and the RAS-I group was significant (p < 0.05). Maintenance of sinus rhythm was achieved in 9 of 25 patients (36%) in the bepridil group, and in 22 of 35 patients (62%) in the RAS-I group with persistent atrial fibrillation. The difference between the bepridil group and the RAS-I group was significant (p < 0.05). Bepridil plus RAS-I was particularly effective at preventing the recurrence of atrial fibrillation in patients with left ventricular dysfunction (left ventricular ejection fraction < 50%). CONCLUSIONS: Combination therapy with RAS-I and bepridil may be useful for maintenance of sinus rhythm.