Comparative efficacy of amiodarone with ivabradin combination or amiodarone with bisoprolol combination in the prevention of atrial fibrillation recurrence in pa- tients with left ventricular diastolic dysfunction

Abstract

Aim. To study the efficacy of use of amiodarone with ivabradine combination or amiodarone with bisoprolol combination in the prevention of atrial fibrillation (AF) recurrence in patients (pts) with left ventricular diastolic dysfunction (LVDD) after conversion to sinus rhythm. Material and methods. 65 patients (40 males, 25 females) aged 53±8 years with persistent AF and LVDD were included into the study and randomized into 3 groups to receive ivabradine and amiodarone (22 pts), bisoprolol and amiodarone (22 pts) or amiodarone alone (21 pts). Left atrium (LA) volume indices, LA longitudinal strain rate (LASR) in systole, LV mass index, mean heart rate (HR), 24-hour HR variability and the incidence of AF by 96 h ECG monitoring were measured after the titration period, and after 3 and 6 months of follow-up. Results. After 6 months of follow-up group 1 revealed significantly lower maximum LA volume index (21.3±2.4 vs 25.2±3.0 and 28.7±3.6 ml/m 2 in the 2nd and control groups, respectively), P-wave LA volume index (15.3±3.5 versus 18.1±3.8 and 20.4±4.0 ml/m 2 in the 2nd and control groups, respectively), and LA systolic volume index (7.3±1.2 versus 9.4±1.6 and 9.6±1.7 ml/m 2 in 2nd and control groups, respectively). The incidence of side effects in group 1 was significantly less than that in group 2 and was not different compared with control group. Conclusion. Ivabradine and amiodarone combination provides better prevention of AF recurrence and less side-effects in pts with LVDD and persistent AF after sinus rhythm restoration as compared with bisoprolol and amiodarone combination, it also reduces LA maximum, conduit and systolic volumes, and increases LASR.