Irbesartan for the Prevention of Atrial Arrhythmias and Cardiac Electrical Remodeling in Patients With Hypertension and Permanent Pacemakers

Inclusion Criteria: Sinus Node Dysfunction (with or without AV conduction disturbance) Permanent, atrial or dual-chamber pacemaker implanted > 2 months before enrollment and with ability to record and store atrial high-rate episodes, frequency of mode switches and to perform non-invasive electrophysiologic testing History of at least 6 AHRE in the last 6 months (rate > 220/min, duration of > 2 minutes History of prior diagnosis of hypertension and/or treated for hypertension OR two documented BP > 130/85 (measurements done at least one week apart) Exclusion Criteria: Permanent or persistent AF or more than 6 episodes of symptomatic paroxysmal AF in the previous 6 months Documented Cr >200 umol/L and K+ >5.2 mmol/L in the previous 3 months Current treatment with a potassium sparing diuretic, unless serum potassium known to be in the normal range LV ejection fraction known to be < 40 % Moderate or severe mitral regurgitation (3+, 4 +) Mitral stenosis of more than mild severity Aortic stenosis with mean gradient of > 25 mmHg Angina at rest in the last 2 months, or current CCS Class 3 or 4 angina Unipolar atrial lead Previous AV node ablation P-wave amplitude less than 1.5 mV Current therapy with an ACE inhibitor, ARB or aldosterone antagonist Current or planned (within 6 months) with an anti-arrhythmic medication (amiodarone, sotalol, flecainide, propafenone, quinidine, dofetilide