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Europace Advance Access originally published online on August 6, 2009
Europace 2009 11(10):1301-1307; doi:10.1093/europace/eup220
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Atrial Fibrillation - clinical issues

Effects of angiotensin receptor blockade on serial P-wave signal-averaged electrocardiograms after electrical cardioversion of persistent atrial fibrillation

Finn Hegbom1,*, Arnljot Tveit2, Irene Grundvold1, Harald Arnesen1 and Pal Smith2

1 Department of Cardiology, Ulleval University Hospital, 0407 Oslo, Norway; 2 Department of Internal Medicine, Asker and Baerum Hospital, 1309 Rud, Norway

Aims: To evaluate the effects of the angiotensin II type 1 receptor blocker candesartan on P-wave signal-averaged electrocardiogram (P-SAECG) after electrical cardioversion in patients with atrial fibrillation (AF).

Methods and results: One hundred and seventy-one patients with persistent AF were randomized to receive candesartan 8 mg/day or placebo for 3–6 weeks before and candesartan 16 mg/day or placebo for 6 months after electrical cardioversion. P-SAECG was recorded in 114 patients (57 in each treatment group) after cardioversion and repeated in those with sinus rhythm at 1 and 6 weeks, and 3 and 6 months. Filtered P-wave duration (FPD), root-mean-squared (RMS) voltages of the terminal 40 ms of the filtered P-wave, RMS voltage of the entire filtered P-wave, and the integral of the voltages in the entire PD were analysed. No effects of candesartan were observed on any P-SAECG parameter at baseline. In the subgroup of patients in sinus rhythm after 6 months, FPD was significantly shorter both at baseline (151 ± 16 vs. 163 ± 16 ms) and at 6 months (143 ± 12 vs. 153 ± 15 ms) in the candesartan (n = 15) compared with the placebo group (n = 21).

Conclusion: Treatment with candesartan was associated with a shorter FPD in patients remaining in sinus rhythm for 6 months.

Key Words: Atrial fibrillation, Cardioversion, P-SAECG, Angiotensin blocker

* Corresponding author. Tel: +47 22119448, Fax: +47 22119060, Email: finn.hegbom{at}medisin.uio.no

Manuscript submitted 23 April 2009. Accepted after revision 16 July 2009.


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