Atrial fibrillation (AF) is a common arrhythmia in clinical practice, and may result in serious complications (1). Direct current cardioversion of persistent AF is the most effective treatment for the restoration of sinus rhythm but it may be hampered by high recurrence rates (2).One of the accepted mechanisms of AF recurrence is electrical and Aim: Angiotensin-converting enzyme (ACE) inhibitors and beta blockers were shown to be eff ective in prevention of atrial fi brillation (AF) recurrences after electrical cardioversion, by interfering with atrial structural and electrical remodeling. In this study, we aimed to compare the eff ects of ACE inhibitor cilazapril and beta blocker metoprolol after cardioversion of AF in terms of sinus rhythm maintenance. Patients and Methods:The study population comprised 120 patients with persistent atrial fi brillation (>7 days) who underwent successful cardioversion. Randomization into 3 groups was done after successful cardioversion. Group I (n=41) was treated with amiodarone, group II (n=41) was treated with amiodarone plus metoprolol, and group III (n=38) was treated with amiodarone plus cilazapril. The primary end-point of the study was the recurrence rates between groups at one year and with those who recurred, the time to recurrence of AF.Results: After 1 year follow-up, maintenance of sinus rhythm were similar among groups (KaplanMeier analysis, 24%, 37% and 26% respectively; log rank=0.3). There was no diff erence among groups with respect to time to recurrence of AF. Conclusion:Patients treated with amiodarone only, amiodarone plus metoprolol and amiodarone plus cilazapril had similar rates of recurrence of AF. Key Words: Atrial fi brillation, cardioversion, angiotensin-converting enzyme inhibitors, beta blockersAmaç: Atriyal fi brilasyonun (AF) elektriksel kardiyoversiyonu sonrasında, anjiyotensin dönüştürü-cü enzim (ACE) inhibitörleri ve beta blokerlerin atriyal yapısal ve elektriksel remodeling' i azaltmak suretiyle AF nükslerini azalttığı gösterilmiştir. Bu çalışmada, kardiyoversiyon sonrasında ACE inhibitörü cilazapril ve beta bloker metoprolol' ün sinüs ritmi idamesindeki etkileri karşılaştırıldı. Hastalar ve Yöntem:Çalışmaya persistan AF'si olup başarılı kardiyoversiyon yapılan 120 hasta alındı. Kardiyoversiyon sonrasında hastalar 3 gruba randomize edildi. Grup I' e (n=41) amiodaron, Grup II' ye (n=41) amiodaron+metoprolol, Grup III' e (n=38) amiodaron+cilazapril verildi. Çalışma-nın primer sonlanım noktası AF nüks oranları ve AF nüksü görülenlerde nükse kadar geçen zaman idi.Bulgular: Bir yıllık takip sonunda gruplar arasında sinüs ritmi idamesi arasında anlamlı fark saptanmadı (Kaplan Meier analizi, sırasıyla %24, %37 and %26; log rank=0.3). AF nüks zamanları açı-sından da gruplar arasında fark gözlenmedi.Sonuç: Amiodaron, amiodaron+metoprolol veya amiodaron+cilazapril tedavilerinin AF nüksü üzerine etkileri benzer bulunmuştur.Anahtar Kelimeler: Atriyal fi brilasyon, kardiyoversiyon, anjiyotensin dönüştürücü enzim inhibitörleri, beta blokerler
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