Related Experiment Video

Updated: Jul 3, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Fibrillatory rate response to candesartan in persistent atrial fibrillation

Andreas Bollmann1, Arnljot Tveit, Daniela Husser

  • 1Department of Cardiology, Lund University, Lund, Sweden. andreas.bollmann@kard.lu.se

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|July 31, 2008
PubMed

Insights

Candesartan reduced atrial fibrillation (AF) fibrillatory rate in patients with high baseline rates, but did not improve cardioversion success. Lower fibrillatory rates (<360 fpm) predicted successful cardioversion but not AF recurrence.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Pharmacology

Background:

  • Angiotensin-receptor blockers (ARBs) may have anti-arrhythmic effects in atrial fibrillation (AF).
  • The precise mechanisms by which ARBs influence AF and cardioversion outcomes remain incompletely understood.
  • This study investigated candesartan's impact on AF fibrillatory rate and its relationship with cardioversion success.

Purpose of the Study:

  • To test if candesartan reduces atrial fibrillatory rate in patients with persistent AF.
  • To determine if fibrillatory rate and its response to candesartan correlate with cardioversion outcomes.

Main Methods:

  • A post hoc analysis of the randomized, placebo-controlled CAPRAF trial was conducted.
  • Patients received either candesartan 8 mg daily or placebo, without other anti-arrhythmic drugs.
  • Fibrillatory rate was measured using ECG lead V1 via spatiotemporal QRST cancellation and time-frequency analysis.

Main Results:

  • Candesartan significantly reduced fibrillatory rate (399 vs. 388 fpm, P=0.04), while placebo did not (402 vs. 402 fpm, P=0.986).
  • This reduction was significant only in patients with high baseline fibrillatory rates (>420 fpm).
  • Successful cardioversion was achieved in 100% of patients with on-treatment rates <360 fpm, versus 83% with higher rates (P=0.02).

Conclusions:

  • Candesartan decreases the fibrillatory rate in persistent AF, primarily in patients with high baseline rates.
  • This effect of candesartan on fibrillatory rate is not associated with improved cardioversion success.
  • Fibrillatory rates below 360 fpm correlate with successful cardioversion but not with reduced AF recurrence.
Abstract

More Related Videos

Transesophageal Atrial Burst Pacing for Atrial Fibrillation Induction in Rats05:12

Transesophageal Atrial Burst Pacing for Atrial Fibrillation Induction in Rats

Published on: February 14, 2022

Related Concept Videos

Antihypertensive Drugs: Angiotensin II Receptor Blockers01:30

Antihypertensive Drugs: Angiotensin II Receptor Blockers

In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
Dose-Response Relationship: Potency and Efficacy01:22

Dose-Response Relationship: Potency and Efficacy

The potency of a drug is the measure of its ability to produce a biological response and can be compared by looking at the half-maximum effective concentration or EC50 values of different drugs. A lower EC50 value indicates higher potency of the drug. In the dose–response curve of two antihypertensive drugs, candesartan and irbesartan, a significant difference is observed in their EC50 values. A lower EC50 value for candesartan indicates that it is more potent than irbesartan, as it produces...
Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers01:20

Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers

Class IV antiarrhythmic drugs, such as verapamil and diltiazem, block calcium channels. They primarily affect the heart, slowing the conduction in calcium-dependent tissues like the SA and AV nodes. These drugs manage reentrant supraventricular tachycardia (SVT) and reduce ventricular rate in atrial flutter/fibrillation.
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Disturbances in Heart Rhythm01:29

Disturbances in Heart Rhythm

Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias01:25

ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias

Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...