Angiotensin-Converting Enzyme Inhibitor Improves The Effect Of Amiodarone On Maintaining Sinus Rhythm In Patients With Persistent Atrial Fibrillation

Objective:To investigate whether angiotensin converting enzyme inhibitor (ACEI) can improve the effect of amiodarone on maintaining sinus rhythm of patients with persistent atrial fibrillation and to clucidete its mechanism. Methods:Fifty-four patients with reconstructed sinus rhythm on oral amiodarone were divided into two groups; ACEI group (n = 23) and non-ACEI group (n =31 ). The patients on amiodarone were followed up for 12 months. The rates of sinus rhythm were calculated at different time points (3 , 6, 9 and 12 months). Dispersion of P wave (Pd) was measured at 24 hours,6 and 12 months after sinus rhythm was rebuilt. Ultrasonic cardiography was also performed to explore changes of left atrial diameter (LAD) , left ventricle end-diastolic diameter (LVEDD) , left ventricle ejection fraction (LVEF) and E/A ratio immediately and at 24 hours and 12 months after sinus rhythm being rebuilt. Results:The rate of sinus rhythm in ACEI group was significantly higher than that in non-ACEI group at 9 and 12 months, respectively (60.87% vs 29. 03% ,P<0. 05;52. 17% vs 22.58% ,P<0. 05). Pd was significantly shortened in ACEI group at 12 months (37. 50±7. 54 ms vs 48. 57±3. 78 ms,P =0. 001). In ACEI group, LAD was decreased (3. 23±0. 15 cm vs 3. 50±0. 28 cm,P = 0. 009) and the diaslolic function of left ventricle (E/A ratio) was significantly improved(P=0. 039)at 12 months. Conclusions : ACEI does improve the effect of amiodarone on maintaining sinus rhythm of patients with persistent atrial fibrillation. It can also improve electrophysiological and morphological remodeling of left atrium.