Relationship between long-term preventive efficacy of cibenzoline and atrial natriuretic peptide in patients with paroxysmal atrial fibrillation

摘要

OBJECTIVES: The relationship between the long-term efficacy of the antiarrhythmic agent cibenzoline in preventing lone paroxysmal atrial fibrillation (PAf) and plasma concentrations of atrial natriuretic peptide (ANP) and catecholamine was investigated during sinus rhythm and PAf. METHODS: Plasma concentrations of ANP, epinephrine, norepinephrine and dopamine during sinus rhythm and PAf were measured in 87 patients (70 men, 17 women, mean age 64 +/- 11 years) with lone-PAf. All patients received cibenzoline (300 mg/day) after cardioversion, and they were divided into the no recurrence group (n = 28) and the recurrence group (n = 59). Mean follow-up period was 41 +/- 29 months. RESULTS: The plasma concentration of ANP was significantly higher during PAf (110.2 +/- 65.0 pg/ml) than during sinus rhythm (39.9 +/- 27.8 pg/ml, p < 0.01) for all patients. The concentrations of epinephrine, norepinephrine and dopamine during PAf were all similar to those during sinus rhythm. Patient characteristics showed no statistically significant difference between the no recurrence and recurrence groups. In the recurrence group, the incidence of thromboembolism was significantly higher (30.5% vs 10.7%) and the period of PAf was significantly longer (26.8 +/- 43.6 vs 12.4 +/- 21.2 months) than in the no recurrence group (both, p < 0.05). The plasma concentrations of ANP during sinus rhythm were similar in the no recurrence group (33.1 +/- 20.1 pg/ml) and the recurrence group (43.5 +/- 30.3 pg/ml), but was significantly higher during PAf in the no recurrence group (142.6 +/- 76.5 pg/ml) than in the recurrence group (95.8 +/- 54.2 pg/ml, p < 0.01). The ratio of ANP level during PAf to that during sinus rhythm in the no recurrence group (5.0 +/- 2.5) was significantly greater than that in the recurrence group (3.2 +/- 2.5, p < 0.01). CONCLUSIONS: Patients without recurrence of PAf under treatment with cibenzoline have preserved capacity of ANP secretion compared with patients with recurrence.