Olmesartan Reduces New-onset Atrial Fibrillation and Atrial Fibrillation Burden after Dual-chamber Pacemaker Implantation in Atrioventricular Block Patients

• Published in: Chinese medical journal 2016-09, Vol.129 (18), p.2143-2148
• Main Authors: Zhang, Hang, Pan, Chang, Zhang, Juan, Zhu, Lin-Lin, Huang, Kai, Zhong, Yun, Hu, Zuo-Ying
• Format: Article
• Language: English
• Subjects: Aged; Angiotensin II Receptor Antagonist; Atrial Fibrillation; Olmesartan; Pacemaker; Ventricular Pacing; Angiotensin Receptor Antagonists - therapeutic use; Atrial fibrillation; Atrial Fibrillation - drug therapy; Atrioventricular Block - drug therapy; Cardiac patients; Care and treatment; Female; Health aspects; Humans; Imidazoles - therapeutic use; Male; Middle Aged; Original; Pacemakers; Single-Blind Method; Tetrazoles - therapeutic use; 传导阻滞; 双腔; 心脏病患者; 心脏起搏器; 房颤; 植入; 血管紧张素II; 负荷
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.189924

Background： Atrial fibrillation （AF） is the rnost frequent tachyarrhythmia in patients with a permanent pacemaker. Angiotensin II receptor antagonists have a protective effect against the occurrence of AF in patients with heart diseases. This study aimed to assess the effectiveness of olmcsartan in the prevention of new-onset AF and AF burden in atrioventricular block （AVB） patients with dual-chamber （DDD） pacemaker implantation. Methods： This was a single-center, prospective, randomized, single-blind, controlled clinical study. A total of 116 AVB patients, who received DDD pacemakers implantation with the percentage of ventricular pacing （VP%） _〉40% from April 22, 2011 to December 24, 2012, were prospectively randomized to olrnesartan group （20 mg per day; n - 57） or control group （n = 59）. Patients were lbllowed up using pacernaker prograrnming± 12-lead electrocardiography in the intrinsic sinus rhythm, laboratory examinations, and transthoracic echocardiography at 24 months. Atrial high rate events （AHREs） were defined as 180 beats/min over a minimum of 5 min. AF burden was calculated by the number of hours with AHREs divided by the number of measurement hours. Results： Ten （17.5%） patients in the olmesartan group and 24 patients （40.7%） in the control group occurred new-onset AF, and the difference between two groups was statistically significant （P = 0.04）. AF burden was lower in olmesartan group than that in control group （8.02 ± 3.10% vs. 13.66 ± 6.14%, P = 0.04）. There were no significant differences in mean days to the first occurrence of AHREs and mean cumulative numbers of AHREs between two groups （P = 0.89 and P = 0.42, respectively）. Moreover, olmesartan group had smaller values of maximal P-wave durations and P-wave dispersion （PD） after 24 months follow-up compared with the control group （ 109.5 ± 7.4 ins vs. 113.4 ± 7.1 ms, P = 0.00; and 40.6 ± 4.5 ms vs. 43.3 ± 4.4 ins, P - 0.02, respectively）. Left ventricular end-diastolic diameter and left ventricular qiection traction were not significantly diiTerent between two groups （both P 〉 0.05）. Conclusion： This study suggested that 24-month ofolmesartan therapy could reduce new-onset AF and AF burden in patients with DDD pacemakers.