ARB治疗房颤(GISSI AF).ppt

* * * * * * * * * * * * * * * * * * * * Study Results Background: experimental data Remodeling, which appears early after the onset of AF, plays an important role in the initiation and maintenance of AF: electrical: shortening of atrial effective refractory period (AERP) associated with loss of rate dependency of the AERP led to an increased atrial vulnerability structural: rapid atrial rates are associated with enlargement of both atrial cavities, leading to structural remodeling In animal models, blockers of the RAAS have been shown to be able to modulate both types of remodeling Cardiovasc Res 2002; 54:456–461 J Am Coll Cardiol 2003; 41:2197–2204 Circulation 2001; 104:2608–2614 Healey JS et al. JACC 2005; 45:1832-39 To evaluate whether in patients with previous AF episodes treated with the best recommended therapies the addition of valsartan can prevent AF recurrence Visit 1 2 Week Days -5 to -1 Day 0 Randomization 3 2 4 4 5 8 6 24 7 52 Study Drug Treatment placebo placebo placebo 80 mg valsartan 160 mg valsartan 320 mg valsartan Study Design All patients have been provided with a transtelephonic monitoring tool Inclusion criteria Male or female patients ?40 years of age Sinus rhythm At least two ECG documented episodes of symptomatic AF in the previous 6 months or After a successful cardioversion for AF performed between 14 days and 48 hours before randomization Written informed consent to participate in the study prior to any study procedure At least one of the following underlying cardiovascular diseases/comorbidities: heart failure/documented history of LV dysfunction (defined as an EF 40%) history of hypertension ?6 months with/without LVH type II diabetes mellitus documented history of stroke or peripheral vascular disease documented history of coronary artery disease lone atrial fibrillation with documented LA dilation (LA diameter ?45 mm for men and ? 40 mm for women) Inclusion criteria Co-primary End-points Time to first recurrence of AF Rate o