P2099 Spontaneus versus post-ablation related conversion rate to sinus rhythm after different cardiosurgical procedures

Abstract Aims Rapid restoration of sinus rhythm using pharmacological cardioversion is commonly indicated in patients with symptomatic recent-onset atrial fibrillation (AF). The objectives of this large, international, multicenter observational study were to determine the safety and effectiveness of intravenous (IV) vernakalant for conversion of AF to sinus rhythm in daily practice. Methods and Results Consenting patients with symptomatic recent-onset AF (< 7 days) treated with IV vernakalant were enrolled and followed up to 24 h after the last infusion or until discharge, in order to determine the incidence of predefined serious adverse events (SAEs) and other observed SAEs and evaluate the conversion rate within the first 90 min. Overall, 2009 treatment episodes in 1778 patients were analyzed. The age of patients was 62.3 ± 13.0 years (mean ± standard deviation). Median AF duration before treatment was 11.1 h (IQR 5.4–27.0 h). A total of 28 SAEs occurred in 26 patients including 19 predefined SAEs, i.e., sinus arrest (n = 4, 0.2%), significant bradycardia (n = 11, 0.5%), significant hypotension (n = 2, 0.1%), and atrial flutter with 1:1 conduction (n = 2, 0.1%). There were no cases of sustained ventricular arrhythmias or deaths. All patients who experienced SAEs recovered fully (n = 25) or with sequelae (n = 1). Conversion rate to sinus rhythm was 70.2%, within a median of 12 min (IQR 8.0–28.0 min). Conclusions This large multicenter, international observational study confirms the good safety profile and the high effectiveness of vernakalant for the rapid cardioversion of recent-onset AF in daily hospital practice.

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Cox maze IV versus left atrial reduction for atrial contraction restoration

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319841512 ◽

2019 ◽

Vol 27 (5) ◽

pp. 353-361

Author(s):

Dena K Firmansyah ◽

Amiliana M Soesanto ◽

Dicky A Hanafy ◽

Arinto Bono

Keyword(s):

Mitral Valve ◽

Sinus Rhythm ◽

Conversion Rate ◽

Left Atrial ◽

Left Atrial Volume ◽

Maze Procedure ◽

Volume Index ◽

Filling Fraction ◽

Left Atrial Volume Index ◽

Atrial Contraction

Background The Cox maze procedure is the gold-standard concomitant surgical procedure to restore sinus rhythm in rheumatic mitral valve disease with atrial fibrillation. Left atrial reduction surgery was found to be beneficial for rhythm conversion, but no study has investigated its efficacy compared to the Cox maze procedure for atrial contractility restoration. We aimed to compare the early success rate of left atrial contractility restoration with the Cox maze procedure and left atrial reduction in rheumatic subjects. Methods Preoperative and within one-month postoperative electrocardiograms and echocardiograms of patients who underwent a Cox maze IV procedure or left atrial reduction with mitral valve surgery were compared. Effective atrial contraction was defined as A wave peak velocity ≥10 cm·s−1 or atrial filling fraction ≥20%. Results Ninety patients (mean age 40.6 ± 10.2 years, 66.7% female) were divided equally into group A (Cox maze IV) and group B (left atrial reduction). The early sinus rhythm conversion rate was 64.4% versus 24.4% ( p < 0.001) in groups A and B, respectively. In patients with restored sinus rhythm, contractility was restored in 41.4% and 36.4% ( p = 1.000). Postoperative left atrial volume index ≤76 mL·m−2 was an independent variable associated with early atrial contractility restoration in both groups (prevalence rate 0.97, p = 0.007). Conclusions In rheumatic subjects, the early sinus rhythm conversion rate was significantly higher after Cox maze IV compared to left atrial reduction, but for restoring left atrial contractility, left atrial reduction was not inferior to Cox maze IV.

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Left Atrial Size Reduction Improves the Sinus Rhythm Conversion Rate after Radiofrequency Ablation for Continuous Atrial Fibrillation in Patients Undergoing Concomitant Cardiac Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2005-865873 ◽

2006 ◽

Vol 54 (1) ◽

pp. 34-38 ◽

Cited By ~ 11

Author(s):

M. Scherer ◽

P. Therapidis ◽

A. Miskovic ◽

A. Moritz

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Radiofrequency Ablation ◽

Sinus Rhythm ◽

Conversion Rate ◽

Left Atrial ◽

Size Reduction ◽

Left Atrial Size ◽

Atrial Size

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Conversion of Atrial Fibrillation after Cardiosurgical Procedures by Vernakalant® as an Atrial Repolarization Delaying Agent (ARDA)

The Heart Surgery Forum ◽

10.1532/hsf.1970 ◽

2018 ◽

Vol 21 (3) ◽

pp. 201 ◽

Cited By ~ 6

Author(s):

Hannan Dalyanoglu ◽

Arash Mehdiani ◽

Jan Philipp Minol ◽

Nihat Firat Sipahi ◽

Hug Aubin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Conversion Rate ◽

Artery Bypass ◽

Demographic Data ◽

Bypass Graft ◽

Mean Time ◽

Cardiac Operations ◽

New Onset

Background: Postoperative, new-onset atrial fibrillation (POAF) is one of the most common complications after cardiosurgical procedures. Vernakalant has been reported to be effective in the conversion of POAF. The aim of this study was to evaluate the efficacy and safety of vernakalant for atrial fibrillation after cardiac operations, and to investigate predictors for the success of vernakalant treatment. Patients and Methods: Post-cardiac surgery patients with new-onset of atrial fibrillation (AF) were consecutively enrolled in this study. Demographic data as well as intraoperative and postoperative parameters were analyzed. Vernakalant administration was primarily started 5.5 hours after new-onset POAF: 3 mg/kg intravenously over 10 min, and in case of non-conversion, a second dose of 2 mg/kg intravenously over 10 min. Results: 129 consecutive patients (70.2 ± 9.1 years) were included: 61 patients with coronary artery bypass graft (CABG) surgery, 49 patients with isolated valve procedures, and 19 patients with combined procedures (CABG and valve). Conversion in sinus rhythm was achieved after the first vernakalant dose in 57 patients (44%), and after the second dose in 41 patients (32%). The mean time to conversion was 13.7 ± 14.1 min. The patients receiving valve procedures depicted a significantly lower conversion rate. The following variables lowered conversion rate: no preoperative beta blocker, postoperative troponin levels >500 ng/L, and systolic blood pressure >140 mmHg. At the first follow-up, 92% of the converted patients showed sinus rhythm, while 80% of the non-responders showed sinus rhythm (P < .01). Conclusions: The POAF was effectively converted by vernakalant. The conversion rate of POAF after valve surgery was lower when compared to isolated CABG.

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Abstract 15742: An Open-label, Multicenter Study of Flecainide Acetate Oral Inhalation Solution Shows Acute Conversion of Recent-onset, Symptomatic Atrial Fibrillation to Sinus Rhythm in a Dose- and Concentration-dependent Manner

Circulation ◽

10.1161/circ.142.suppl_3.15742 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Harry Crijns ◽

Jeremy N Ruskin ◽

Arif Elvan ◽

Nadea Al-Windy ◽

Ype Tuininga ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Conversion Rate ◽

Plasma Concentrations ◽

Maximum Plasma ◽

Dependent Manner ◽

Open Label ◽

Recent Onset ◽

Conversion Rates ◽

Flecainide Acetate

Introduction: Oral and intravenous (IV) flecainide are recommended as first line therapy for pharmacological cardioversion of recent-onset atrial fibrillation (AF) in patients without known relevant structural heart disease. In the present open-label, dose-escalation study, the feasibility of using flecainide acetate inhalation solution (FlecIH) for acute conversion of recent-onset AF to sinus rhythm (SR) was evaluated. Hypothesis: We hypothesized that FlecIH quickly gives rise to plasma concentrations sufficient to rapidly restore SR in patients with recent-onset AF. Methods: Patients (n=95) with symptomatic AF (for ≤ 48 hours) were enrolled and self-administered FlecIH using a breath-actuated nebulizer (30 mg [n=10], 60 mg [n=20], 90 mg [n=21], 120 mg [n=17], and 120 mg in a formulation containing saccharin [n=27]). Blood samples were collected for flecainide plasma concentrations, electrocardiograms were obtained, cardiac rhythm with a 4-hour Holter and vital signs were monitored, and adverse events (AEs) were recorded. Patients who did not convert to SR were offered alternative treatment per the investigator’s discretion. Results: Conversion rates increased with dose and maximum plasma concentrations (C max ) of flecainide. At the highest dose, 45% of patients converted to normal SR. Patients with C max > 300 ng/mL had a conversion rate of 53% whereas those with C max < 200 ng/mL had a conversion rate of 33%. The median time to conversion was 3.5 min after FlecIH administration. AEs were typically mild and transient. Commonly reported AEs associated with inhalation of flecainide included: cough, throat pain, and throat irritation; at the highest dose with the formulation containing saccharin, these AEs were reported for 37%, 11%, and 4% of patients, respectively. Cardiac AEs consistent with those observed with oral and IV flecainide and considered serious were uncommon and included 2 post-conversion pauses and 1 bradycardia, and 1 atrial flutter with 1:1 atrioventricular conduction; none required treatment and all resolved without sequelae. Conclusions: FlecIH was well tolerated. Inhalation of FlecIH at the 120 mg dose yielded therapeutic plasma levels and conversion rates within the range reported for oral and IV administration.

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