Treatment of Long-Lasting Persistent Atrial Fibrillation Using Minimally Invasive Surgery Combined With Irbesartan

• Published in: The Annals of thoracic surgery Vol. 91; no. 4; pp. 1183 - 1189
• Main Authors: Wang, Jian-Gang, MD, Li, Yan, MD, Shi, Jia-Hai, MD, Han, Jie, MD, Cui, Yong-Qiang, MD, Luo, Tian-Ge, MD, Meng, Xu, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2011; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Atrial Fibrillation - drug therapy; Atrial Fibrillation - surgery; Biological and medical sciences; Biphenyl Compounds - therapeutic use; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiothoracic Surgery; Catheter Ablation; Combined Modality Therapy; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures; Pneumology; Prospective Studies; Surgery; Tetrazoles - therapeutic use; Time Factors; 24; Imidazole derivatives; Tetrazole derivatives; Arrhythmia; Atrial fibrillation; Peptide hormone; Cardiovascular disease; Excitability disorder; Octapeptide; Minimally invasive surgery; Treatment; Irbesartan; Biphenyl derivatives; Heart disease; Anesthesia; Antihypertensive agent; Sartan derivatives; Angiotensin antagonist; Circulatory system; Angiotensin II; Cardiology; Long lasting
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2010.11.063

Background Recent studies have provided evidence that the renin-angiotensin system plays a key role in the onset and progression of atrial fibrillation (AF). The current study was designed to assess the efficacy and safety of video-assisted minimally invasive radiofrequency ablation for long-lasting persistent AF, as well as to evaluate the efficacy of the angiotensin-receptor blocker irbesartan for maintaining sinus rhythm. Methods Over a period of 4 years, 83 patients with long-lasting persistent AF underwent minimally invasive ablation at our center. The patients were randomly assigned to two groups, one group treated with ablation plus irbesartan, and the other with ablation alone. Follow-up ranged from 1 to 3.6 years. Results No patient died postoperatively. At the end of the procedure, 38 patients (45.7%) were in sinus rhythm, and 36 (43.4%) had AF. At the last follow-up, 65 patients (80.2%) were in sinus rhythm, 38 (92.7%) in group 1 and 27 (67.5%) in group 2 ( p = 0.002). Patients in group 2 had a significantly higher rate of recurrent arrhythmia (Kaplan-Meier analysis, p = 0.004; hazard ratio, 0.24; 95% confidence interval: 0.087 to 0.637). Kaplan-Meier analysis also showed that patients treated with irbesartan had a significantly lower rate of use of antiarrhythmic drugs ( p = 0.02). Conclusions The video-assisted minimally invasive ablation procedure was safe and effective for patients with long-lasting persistent AF. Patients who were additionally treated with irbesartan had a significantly lower rate of AF recurrence than patients who were treated with ablation alone.