Antazoline for pharmacological cardioversion of atrial fibrillation: the results of the high-volume multicenter CANT study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Wybraniec ◽  
A Maciag ◽  
D Miskowiec ◽  
B Ceynowa-Sielawko ◽  
P Balsam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antiarrhythmic Drug ◽  
High Volume ◽  
Antiarrhythmic Therapy ◽  
Hospital Death ◽  
Antiarrhythmic Agents ◽  
Drug Infusion ◽  
Cardiology Department ◽  
Safety Endpoint ◽  
Pharmacological Cardioversion

Abstract Background Antazoline mesylate represents a first generation antihistamine with quinidine-like antiarrhythmic properties, which allows for rapid and effective termination of atrial fibrillation (AF). Despite its widespread use in Polish emergency departments, paucity of data exists concerning safety and efficacy of antazoline in comparison to other antiarrhythmic agents. Purpose This study aimed to evaluate the pooled hitherto data on effectiveness and safety of pharmacological Cardioversion with intravenous ANTazoline (CANT Study) in short-duration atrial fibrillation. Methods This retrospective observational study was performed in 5 medical centers and comprised 1300 patients with paroxysmal or persistent AF who underwent emergent pharmacological cardioversion in the real-world setting of emergency or cardiology department. The choice of antiarrhythmic drug was left to the discretion of attending physician. The exclusion criteria involved permanent AF, other supraventricular arrhythmias, including atrial flutter, chronic antiarrhythmic therapy or preemptive electrical cardioversion. The primary endpoint was restoration of sinus rhythm up to 12 hours after antiarrhythmic drug infusion. The combined safety endpoint was bradycardia <45 bpm, hypotension, syncope or death. Results The mean age of study population was 67.7±11.6 years and the majority of patients were men (52.9%). The median AF episode duration was 10 (4; 24) hours, while median CHA2DS2-VASc score was 3 (2; 4) pts. Antazoline alone was administered in 45.6% of patients (n=593); amiodarone in 22.1% (n=287); propafenone in 11.5% (n=150); sotalol in 0.5% (n=6), while 20.3% (n=264) received overlapping antiarrhythmic therapy. Antazoline had the highest rhythm conversion rate (Figure), which was comparable to propafenone (78.2% vs 72.7%; RR 1.08; 95% CI:0.97–1.20; P=0.175) and superior to amiodarone (vs 66.9%; RR 1.17, 95% CI:1.07–1.28; P=0.0008) and collective amiodarone/propafenone/sotalol treatment (vs 68.6%; RR 1.14; 95% CI:1.06–1.23; P=0.0006). The rate of combined safety endpoint was comparable in patients treated with antazoline and other antiarrhythmic drugs (5.2% vs 3.9%; P=0.297). Among patients treated with antazoline, 29 exhibited bradycardia <45 bpm and 5 patients suffered from hypotension, but no case of syncope, nor in-hospital death was reported. Conclusion Antazoline appears to be an effective antiarrhythmic drug for cardioversion of atrial fibrillation, which is associated with low rate of relatively benign adverse events. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Cardioversion of recent-onset atrial fibrillation using intravenous antiarrhythmics

2021 ◽  
Author(s):  
Samuel Levy
Keyword(s):  
Atrial Fibrillation ◽  
Real Life ◽  
Torsades De Pointes ◽  
Antiarrhythmic Agents ◽  
Success Rates ◽  
Class Iii ◽  
Recent Onset ◽  
New Class ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation

ABSTRACT (195 words) Pharmacological cardioversion using intravenous antiarrhythmic agents is commonly indicated in symptomatic patients with recent-onset atrial fibrillation (AF). Except in hemodynamically unstable patients who require emergency direct current electrical cardioversion, for the majority of hemodynamically stable patients, pharmacological cardioversion represents a valid option and requires the clinician to be familiar with the properties and use of antiarrhythmic agents. The main characteristics of selected intravenous antiarrhythmic agents for conversion of recent-onset AF, the reported success rates and possible adverse events are discussed. Among intravenous antiarrhythmics, flecainide, propafenone, amiodarone, sotalol, dofetilide, ibutilide and vernakalant are commonly used. Antazoline, an old antihistaminic agent with antiarrhythmic properties was also reported to give encouraging results. Intravenous flecainide and propafenone are the only class I agents still recommended by recent guidelines. Intravenous new class III agents as dofetilide and ibutilide have high and rapid efficacy in converting AF to sinus rhythm but require strict surveillance with ECG monitoring during and after intravenous administration because the potential risk of QT prolongation and Torsades de Pointes which can be prevented and properly managed. Vernakalant, a partial atrial selective was shown to have a high success rate and to be safe in real life use.

Pharmacological cardioversion for atrial fibrillation

ESC CardioMed ◽  
2018 ◽  
pp. 2147-2155
Author(s):  
Irina Savelieva
Keyword(s):  
Atrial Fibrillation ◽  
Torsade De Pointes ◽  
Hospital Setting ◽  
Structural Heart Disease ◽  
Electrical Cardioversion ◽  
Electrolyte Imbalance ◽  
Drug Infusion ◽  
Onset Of Action ◽  
Pill In The Pocket ◽  
Pharmacological Cardioversion

Pharmacological or electrical cardioversion is an integral part of rhythm control management. Antiarrhythmic drugs for pharmacological cardioversion include intravenous formulations of flecainide, propafenone, amiodarone, ibutilide, and vernakalant. A ‘pill-in-the-pocket approach’ with a single oral loading dose of flecainide or propafenone is used in selected patients. Pharmacological cardioversion is generally less commonly employed than electrical cardioversion because of the limitations of currently available drugs, such as restriction to patients without structural heart disease (flecainide and propafenone), risk of torsade de pointes (ibutilide), and slow onset of action (amiodarone). Acute pharmacological atrial fibrillation cardioversion is mainly performed in the hospital setting and requires continuous medical supervision and ECG monitoring during and following the drug infusion for at least half of the drug half-life period. Prior to pharmacological cardioversion, electrolyte imbalance should be corrected and anticoagulant therapy should be initiated if indicated.

P1907Propensity score matched analysis of antazoline mesylate vs. amiodarone or propafenone for pharmacological cardioversion of short-duration atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Wybraniec ◽  
W Wrobel ◽  
K Wilkosz ◽  
K Wrona ◽  
K Bula ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Conversion Rate ◽  
Antiarrhythmic Drugs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Number Needed To Treat ◽  
Antiarrhythmic Agents ◽  
Ventricular Ejection Fraction ◽  
Pharmacological Cardioversion

Abstract Background Former studies corroborated promising quinidine-like properties of antazoline mesylate facilitating rapid cardioversion atrial fibrillation (AF). Still, paucity of data exists concerning direct comparison of antazoline to other antiarrhythmic agents. Purpose The study aimed to verify the hypothesis that intravenous antazoline is non-inferior to amiodarone and/or propafenone in terms of rhythm conversion rate and safety among patients with AF. Methods After reviewing 2344 consecutive medical records with I48 code of international classification of diseases (ICD), 505 eligible patients (21.5%) with paroxysmal or persistent AF who underwent emergent pharmacological cardioversion in the real-world setting of emergency department were enrolled in retrospective observational analysis. The choice of antiarrhythmic drug was left to the discretion of attending physician. Antazoline group was separately matched with corresponding amiodarone (n=218) and propafenone (n=90) cohort using propensity score matching (PSM) with nearest neighbor algorithm (ratio 1:1), adjusting for age, sex, arterial hypertension, diabetes, depressed left ventricular ejection fraction, coronary artery disease, history of stroke, AF ablation, CHA2DS2-VASc score, chronic kidney disease and duration of AF episode. The primary endpoint was restoration of sinus rhythm in the emergency department. Results The study population (mean age of 67 (59; 74) years; 53.7% females) was characterized by median AF episode duration of 10.5 (5; 24) hours. Antazoline alone was administered in 23.4% of patients (n=118); amiodarone in 47.5% (n=240); propafenone in 9.9% (n=50); while 19.2% (n=97) received ≥2 antiarrhythmic drugs. Before PSM adjustment, antazoline had comparable rhythm conversion rate to propafenone (85.6% vs. 80.0%; P=0.367) and higher than amiodarone treatment (vs. 66.7%, P=0.0002), and greater than combined amiodarone/propafenone group (68.6%; RR 1.25; 95% CI: 1.12–1.39, P=0.0001). After PSM, the use of antazoline was associated with the efficacy similar to propafenone (82.2% vs. 80.0%, RR 1.03; 95% CI: 0.84–1.25, P=0.788) and superior to amiodarone (85.3% vs. 67.0%, RR 1.27, 95% CI: 1.09–1.48, P=0.0019, number needed to treat 5.5; Figure). No major adverse actions were reported in the antazoline group. Conclusion Antazoline appears to be an efficacious and safe drug for pharmacological cardioversion of AF in real-life setting, which is at least non-inferior to existing antiarrhythmic drugs. Acknowledgement/Funding None

Antiarrhythmic Drug Therapy of Atrial Fibrillation: Focus on New Agents

2003 ◽  
Vol 8 (1_suppl) ◽  
pp. S27-S31 ◽  
Author(s):  
Paul Dorian
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Potassium Channels ◽  
Antiarrhythmic Drug ◽  
Control Strategies ◽  
Antiarrhythmic Agents ◽  
Antiarrhythmic Drug Therapy ◽  
Animal Disease Models ◽  
Substantial Clinical Benefit ◽  
Ionic Mechanisms

The precise mechanisms of clinical effect of antiarrhythmic agents and the ideal “molecular targets” against arrhythmias, in particular atrial fibrillation, are poorly understood. Current antiarrhythmic drug development, particularly for drugs expected to be active against atrial fibrillation, has focused on drugs with multiple ionic mechanisms of action, in particular on those that block multiple potassium channels. Investigation of antiarrhythmic agents is complicated by the diversity of animal-disease models studied, by the potential multiple mechanisms of arrhythmias, and by the incompletely understood relationships between risks and benefits of antiarrhythmic drug therapy. Furthermore, rhythm control strategies in large groups of patients with atrial fibrillation have failed to show substantial clinical benefit. Nevertheless, drugs that block multiple potassium channels and appear to have relatively little organ toxicity, such as tedisamil, may represent an important new avenue in the therapeutic approach to highly symptomatic arrhythmias such as atrial fibrillation.

scholarly journals Clinical experience of new antiarrhythmic drug refralon for pharmacological cardioversion in patients with atrial fibrillation after pulmonary vein cryoablation

2021 ◽  
Vol 28 (3) ◽  
pp. 55-62
Author(s):  
M. A. Zelberg ◽  
N. Yu. Mironov ◽  
E. B. Maykov ◽  
P. S. Novikov ◽  
Yu. A. Yurichev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Clinical Experience ◽  
Antiarrhythmic Drug ◽  
Persistent Atrial Fibrillation ◽  
Electrical Cardioversion ◽  
Pharmacological Cardioversion ◽  
Clinical Cases

We present two cases of successful pharmacological cardioversion using antiarrhythmic drug refralon in patients with persistent atrial fibrillation after pulmonary vein cryoablation and ineffective electrical cardioversion. These clinical cases represent the first experience of successful use of refralon in patients who underwent cryoablation.

scholarly journals Safety and interaction of direct oral anticoagulants with antiarrhythmic drugs

2021 ◽  
Vol 26 (7) ◽  
pp. 4482
Author(s):  
B. A. Tatarsky ◽  
N. V. Kazyonnova
Keyword(s):  
Atrial Fibrillation ◽  
Antiarrhythmic Drugs ◽  
Warfarin Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Antiarrhythmic Therapy ◽  
Antiarrhythmic Agents ◽  
Thromboembolic Events ◽  
Prevention Of Thromboembolic Events

The use of direct oral anticoagulants minimized the risks associated with vitamin K antagonist (warfarin) therapy. Currently, direct oral anticoagulants have priority over warfarin for the prevention of thromboembolic events in patients with atrial fibrillation and a number of other conditions requiring anticoagulant therapy. Direct oral anticoagulants along with antiarrhythmic therapy are the accepted strategy for atrial fibrillation treatment. At the same time, the effect of drug-drug interactions (DDI) between direct oral anticoagulants and antiarrhythmic drugs, which have common points of metabolic application, has not been fully elucidated. In order to provide effective and safe anticoagulant and antiarrhythmic therapy in patients with AF, it is important to understand the mechanisms and severity of DDI of direct oral anticoagulants and antiarrhythmic agents. This review discusses the issues of DDI of direct oral anticoagulants and antiarrhythmic drugs used to treat atrial fibrillation.

scholarly journals Pleiotropic Effects of Antiarrhythmic Agents: Dronedarone in the Treatment of Atrial Fibrillation

2013 ◽  
Vol 7 ◽  
pp. CMC.S8445 ◽  
Author(s):  
Jordi Heijman ◽  
Gerd Heusch ◽  
Dobromir Dobrev
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Side Effects ◽  
Sinus Rhythm ◽  
Antiarrhythmic Drug ◽  
Clinical Studies ◽  
Antiarrhythmic Agents ◽  
Clinical Testing ◽  
Pleiotropic Actions ◽  
Antiarrhythmic Effects

Atrial fibrillation remains the most common arrhythmia in clinical practice. Dronedarone is an antiarrhythmic drug for the maintenance of sinus rhythm in patients with atrial fibrillation. Dronedarone is an amiodarone derivative developed to reduce the number of extracardiovascular side effects. Dronedarone has undergone extensive experimental and clinical testing during the last decade. On the aggregate, these studies have highlighted a complex set of pleiotropic actions that may contribute to dronedarone's antiarrhythmic effects. In this review, we summarize the clinical studies that have evaluated dronedarone and provide an overview of dronedarone's electrophysiological and nonelectrophysiological pleiotropic actions.

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