P427Influence of ranolazine on cardioversion rate in patients with new onset atrial fibrillation and ischemic disease of the heart

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
B Alyavi ◽  
J K Uzokov ◽  
A X Abdullaev ◽  
D D Payziev
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Therapy Group ◽  
Antiarrhythmic Effect ◽  
Ischemic Disease ◽  
Group I ◽  
Antianginal Effect ◽  
Group Ii ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background Ranolazine is a piperazine derivative, mainly used as antianginal drug in patients with ischemic disease of the heart (IDH). Despite its antianginal effect, it has an antiarrhythmic effect by inhibiting of late sodium and rapid potassium rectifier current. Aim of the study was to assess the additional antiarrhythmic efficacy of ranolazine in patients with new onset atrial fibrillation (AF) and IDH. Material and Methods 168 eligible patients with IDH and short duration of new onset AF were enrolled in this study. Among them, 92 were treated additionally ranolazine to the standart therapy – Group I while 76 only with standart therapy – Group II. The choice of antiarrhythmic drug for cardioversion was either amiodarone or propafenone at the discretion of the doctor. Primary endpoint was recovering of sinus rhythm. All statistical analysis were performed using student t-test. Results Mean age of patients was 66 ± 11.5 years, male 48% in ranolazine group (Group I) and 64.5 ± 12.0 years, male 46% in Group II, and there were no statistically significant differences between two groups. Both groups of patients were characterized by median AF episode duration of 12 (4; 24) hours. Amiadoron was administered in 70 % (n = 65) of patients in Group I and in 77% (n = 59); propafenon in 30% (n = 17) of patients in Group I and 23% (n = 17) in Group II. Cardioversion rate was significantly higher in Group I than Group II (87% vs. 74%, P < 0.05;). There were not observed safety endpoints in Group I whereas 3 safety endpoints (severe bradycardia and arterial hypotension) were observed in Group II (P > 0.05). Conclusion Adding ranolazine to the standard therapy in patients with IDH seems to have a beneficial role in restoring sinus rhythm in recent new onset AF.

scholarly journals Primary success of electrical cardioversion for new-onset atrial fibrillation and its association with clinical course in non-cardiac critically ill patients: sub-analysis of a multicenter observational study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Nozomu Shima ◽  
Kyohei Miyamoto ◽  
Seiya Kato ◽  
Takuo Yoshida ◽  
Shigehiko Uchino ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trial ◽  
Sinus Rhythm ◽  
Trial Registry ◽  
Clinical Trial Registry ◽  
Icu Discharge ◽  
Primary Success ◽  
Success Group ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background Electrical cardioversion (ECV) is widely used to restore sinus rhythm in critically ill adult patients with atrial fibrillation, although its prognostic value is uncertain. This study aims to elucidate the clinical meaning of successful ECV. Methods This is a sub-analysis of the AFTER-ICU study, a multicenter prospective study with a cohort of 423 adult non-cardiac patients with new-onset atrial fibrillation (AF). Patients that underwent ECV within 7 days after initial onset of AF were included in the sub-analysis. We compared intensive care unit (ICU) and overall hospital mortality, survival time within 30 days, cardiac rhythm at ICU discharge, and the length of ICU and overall hospital stay between patients whose sinus rhythm was restored immediately after the first ECV session (primary success group) and those in whom it was not restored (unsuccessful group). To find the factors related to the primary success of ECV, we also compared patient characteristics, the delivered energy, and pretreatment. Results Sixty-five patients received ECV and were included in this study. Although 35 patients (54%) had primary success, recurrence of AF occurred in 24 of these patients (69%). At ICU discharge, three patients still had AF in the unsuccessful group, but no patients in the primary success group still had AF. ICU mortality was 34% in the primary success group and 17% in the unsuccessful group (P = 0.10). Survival time within 30 days did not differ between the groups. Delivered energy and pretreatment were not associated with primary success of ECV. Conclusions The primary success rate of ECV for new-onset AF in adult non-cardiac ICU population was low, and even if it succeeded, the subsequent recurrence rate was high. Primary success of ECV did not affect the rate of mortality. Pretreatment and delivered energy were not associated with the primary success of ECV. Trial registration UMIN clinical trial registry, the Japanese clinical trial registry (registration number: UMIN000026401, March 31, 2017).

The role of epicardial fat tissue in atrial fibrillation onset in patients with hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tarzimanova ◽  
V.I Podzolkov ◽  
M.V Pisarev ◽  
R.G Gataulin ◽  
K.A Oganesian
Keyword(s):  
Atrial Fibrillation ◽  
Plasma Concentration ◽  
Sinus Rhythm ◽  
Epicardial Fat ◽  
Funding Source ◽  
Fat Tissue ◽  
Hypertensive Patients ◽  
Group I ◽  
Epicardial Fat Tissue ◽  
Group Ii

Abstract Aim To study the influence of epicardial fat tissue (EFT) on atrial fibrillation (AF) occurrence in hypertensive patients. Materials and methods The study included 195 patients with hypertension aged from 38 to 72 years (mean age was 61.5±1.8 years). All patients were divided into two groups: group I included 95 hypertensive patients with paroxysmal AF; 100 patients with hypertension in sinus rhythm were enrolled into group II. Echocardiography was performed to evaluate the thickness of EFT in a parasternal long-axis view. The EFT volume was assessed with computed tomography (CT) scan. The plasma concentration of tissue inhibitor of metalloproteinase-1 (TIMP-1) and metalloproteinase-9 (MMP-9) was measured to evaluate the myocardial fibrosis process. Results There was no significant difference between the studied groups of patients in body mass index: 34.43±1.2 kg/m2 in group I vs 31.97±1.67 kg/m2 in the group II. Waist circumference was significantly higher in group I in comparison with the group II patients: 118.9±3.3 cm vs 110.2±1.4 cm, respectively (p=0.038). EFT thickness was significantly higher in patients with paroxysmal AF (11.6±0.8 mm) in comparison with the patients in sinus rhythm (8.6±0.4 mm) (p<0.001). In group I patients a significant increase of EFT volume (4.6±0.4) in comparison with II group (3.5±0.25) (p=0.002) was noted. A significant positive correlation was revealed in hypertensive patients with paroxysmal AF between EFT volume and left atrial (LA) volume (r=0.7, p=0.022). Also, the plasma concentrations of TIMP-1 and MMP-1 were significantly higher in patients with paroxysmal AF and hypertension. There was a strong positive correlation between EFT volume and plasma concentration of TIMP-1 (r=0.72; p=0.01) and between the EFT volume and the LA volume (r=0.7, p=0.022) in group I patients. Multivariate regression analysis revealed the significant influence of increased EFT thickness more than 10 mm (prevalence ratio (PR) 4.1; 95% CI 1.1; 15.6) and EFT volume more than 6 ml (PR 3.7; 95% CI 1.0; 14.2) on AF occurrence. Conclusion Increased EFT thickness (more than 10 mm) and EFT volume (more than 6 ml) are predictors of AF onset in hypertensive patients. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The complex subject of the Department

scholarly journals Pharmacological cardioversion of recent-onset atrial fibrillation in patients with chronic kidney disease: sub-analysis of the CANT study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Ceynowa-Sielawko ◽  
M Wybraniec ◽  
A Topp-Zielinska ◽  
A Maciag ◽  
D Miskowiec ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Sinus Rhythm ◽  
Public Institution ◽  
Group Iii ◽  
Recent Onset ◽  
Group I ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation

Abstract Purpose Pharmacological cardioversion (PCV) is commonly a primary option for termination of recent-onset atrial fibrillation (AF) at the emergency departments (ED), and there are reports proving that antazoline is a noteworthy agent to restore sinus rhythm. This is a sub-analysis of the CANT study evaluating the effectiveness and safety of antazoline in patients with AF at different stages of chronic kidney disease (CKD). Methods Total n=777 patients admitted to ED for the urgent termination of AF were included into this analysis. We analysed the results concerning effectiveness and safety of PCV with special consideration of antazoline, in patients at 3 stages of CKD defined on the basis of eGFR (CKD-EPI): Group I ≥60 mL/min (n=531), Group II 45–59 mL/min (n=149), and Group III <45 mL/min (n=97). Primary end-point was the termination of AF, a restoration of a sinus rhythm and its persistence until discharge. Results Patients of group III were older and with higher prevalence of comorbidities, however, we have not found statistically significant differences in overall effectiveness of PCV in comparison with the other groups. In patients receiving amiodarone, the PCV success rate was similar in all the studied groups, but along with a renal function decline, it decreased in patients receiving antazoline (79.1 vs 35%; p<0.001), and it increased close to a significant manner in patients receiving propafenone (69.9 vs 100%; p=0.067; Figure). In patients of Group I, antazoline restored a sinus rhythm as effectively as propafenone and amiodarone, however in patients of Group III, both antazoline and amiodarone became less effective in restoring a sinus rhythm than propafenone (p=0.002 and p=0.034, respectively). The rate of safety endpoint was highest in patients of Group III (eGFR<45 mL/min), and it was significantly higher than in patients of Group I and II (p=0.008 and p=0.036, respectively). We have not observed antazoline-related adverse events in any of studied groups of patients. Conclusion This real-world registry analysis revealed a different influence of CKD on individual drug effectiveness, and while propafenone and amiodarone maintained their AF termination efficacy, antazoline became significantly less effective in restoring sinus rhythm. Its favourable safety profile has not changed. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The study received no external funding

scholarly journals Suitability, Efficacy, and Safety of Vernakalant for New Onset Atrial Fibrillation in Critically Ill Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Alain Rudiger ◽  
Alexander Breitenstein ◽  
Mattia Arrigo ◽  
Sacha P. Salzberg ◽  
Dominique Bettex
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Sinus Rhythm ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Pressure Monitoring ◽  
Exclusion Criteria ◽  
Arterial Blood ◽  
Onset Atrial Fibrillation ◽  
New Onset

Objectives. This study investigates the suitability, safety, and efficacy of vernakalant in critically ill patients with new onset atrial fibrillation (AF) after cardiac surgery.Methods. Patients were screened for inclusion and exclusion criteria according to the manufacturers’ recommendations. Included patients were treated with 3 mg/kg of vernakalant over 10 min and, if unsuccessful, a second dose of 2 mg/kg. Blood pressure was measured continuously for 2 hours after treatment.Results. Of the 191 patients screened, 159 (83%) were excluded, most importantly due to hemodynamic instability (59%). Vernakalant was administered to 32 (17% of the screened) patients. Within 6 hours, 17 (53%) patients converted to sinus rhythm. Blood pressure did not decrease significantly 10, 30, 60, and 120 minutes after the vernakalant infusion. However, 11 patients (34%) experienced a transient decrease in mean arterial blood pressure <60 mmHg. Other adverse events included nausea (n=1) and bradycardia (n=2).Conclusions. Applying the strict inclusion and exclusion criteria provided by the manufacturer, only a minority of postoperative ICU patients with new onset AF qualified for vernakalant. Half of the treated patients converted to sinus rhythm. The drug was well tolerated, but close heart rate and blood pressure monitoring remains recommended.

scholarly journals ECG Predictors for New-Onset Atrial Fibrillation Within a Year After Radiofrequency Ablation of Counterclockwise-Rotating Atrial Flutter

2021 ◽  
Vol 8 ◽  
Author(s):  
Hailei Liu ◽  
Zhoushan Gu ◽  
Chao Zhu ◽  
Mingfang Li ◽  
Jincheng Jiao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Atrial Flutter ◽  
P Wave ◽  
Negative Component ◽  
Typical Atrial Flutter ◽  
History Of ◽  
Electrocardiographic Parameters ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background: New-onset atrial fibrillation (AF) after ablation of typical atrial flutter (AFL) is not rare. This study aimed to investigate the predictive value of electrocardiographic parameters on new-onset AF post-typical AFL ablation.Methods: A total of 158 consecutive patients (79.1% males, mean age 57.8 ± 14.3 years) with typical AFL were enrolled between January 2012 and August 2017 in this single-center study. Patients with a history of AF before ablation were excluded. ECGs during sinus rhythm (SR) and AFL were collected. The duration of the negative component of flutter wave in lead II (DFNII), proportion of the DFNII of the total circle length of AFL (DFNII%), amplitude of the negative component of flutter wave in lead II (AFNII), duration (DPNV1), and amplitude (APNV1) of negative component of the P wave in lead V1, and P wave duration in lead II (DPII) during sinus rhythm were measured.Results: During a median follow-up of 26.9 ± 11.8 months, 22 cases (13.9%) developed new-onset AF. DFNII was significantly longer in patients with new-onset AF compared to patients without AF (114.7 ± 29.6 ms vs. 82.7 ± 12.8 ms, p &lt; 0.0001). AFNII was significantly lower (0.118 ± 0.034 mV vs. 0.168 ± 0.051 mV, p &lt; 0.0001), DPII (144.21 ± 23.77 ms vs. 111.46 ± 14.19 ms, p &lt; 0.0001), and DPNV1 was significantly longer (81.07 ± 16.87 ms vs. 59.86 ± 14.42 ms, p &lt; 0.0001) in patients with new-onset AF. In the multivariate analysis, DFNII [odds ratio (OR), 1.428; 95% CI, 1.039–1.962; p = 0.028] and DPII (OR, 1.429; 95% CI, 1.046–1.953; p = 0.025) were found to be independently associated with new-onset AF after typical AFL ablation.Conclusion: Parameters representing left atrial activation time under both the SR and AFL were independently associated with new-onset AF post-typical AFL ablation and may be useful in risk prediction, which needs to be confirmed by further prospective studies.

scholarly journals Assessment of Bipolar Radiofrequency Ablation Combined with Coronary Artery Bypass Surgery for Management of Atrial Fibrillation in Cardiac Patients

2020 ◽  
Vol 23 (6) ◽  
pp. E826-E832
Author(s):  
Hamdy Singab
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Radiofrequency Ablation ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Nyha Class ◽  
Bipolar Radiofrequency ◽  
Group I ◽  
Group Ii

Background: Atrial fibrillation (AF) is a common problem in patients undergoing coronary artery bypass graft (CABG). For AF ablation, bipolar radiofrequency ablation (BRA) achieves complete transmural ablation lines and reduces the risk of treatment failure. We analyzed the efficacy of BRA for sinus rhythm restoration in patients with AF undergoing CABG. Methods: This prospective study included patients with permanent or paroxysmal AF scheduled to undergo BRA combined with CABG in our institution from May 2014 to June 2020. After discharge from hospital, all patients were seen every 6 months over 5 years to evaluate survival, sinus rhythm restoration, and New York Heart Association (NYHA) class. Results: We enrolled 168 patients, 97 (57.7%) with permanent AF (group I) and 71 (42.3%) with paroxysmal AF (group II) at 60 months. We found that group II patients had better sinus rhythm restoration rates after BRA with CABG than group I patients (P = .005). Overall mortality at 60 months was significantly lower in group II patients (2 [2.8%]) than patients in group I (14 [14.4%]; P = .01). The survival rate was significantly higher in group II than in group I (94% versus 72%; P = .0003) as shown by Kaplan–Meier analysis. The 95% confidence interval of the Cox hazards survival regression ratio was significantly different between groups (0.1792 [0.04069 to 0.7896]; P = .006). Long-term AF (>3 years) before BRA with CABG and permanent AF type were identified as predictors of post-BRA recurrent AF (P = .0001 and P = .005, respectively). NYHA class improved significantly at 60 months compared with baseline (P < .0001). Conclusions: This study identified preoperative AF type and duration as predictors of the success of BRA combined with CABG.

scholarly journals Prognostic impact of restored sinus rhythm in patients with sepsis and new-onset atrial fibrillation

Critical Care ◽  
2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Wen Cheng Liu ◽  
Wen Yu Lin ◽  
Chin Sheng Lin ◽  
Han Bin Huang ◽  
Tzu Chiao Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Prognostic Impact ◽  
Onset Atrial Fibrillation ◽  
New Onset

scholarly journals Predictors of time to conversion of new‐onset atrial fibrillation to sinus rhythm with amiodarone therapy

2020 ◽  
Vol 36 (4) ◽  
pp. 705-711
Author(s):  
Ihsan Dursun ◽  
Sinan Sahin ◽  
Ali Bayraktar ◽  
Omer Faruk Cirakoglu ◽  
Selim Kul ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Amiodarone Therapy ◽  
Onset Atrial Fibrillation ◽  
New Onset

scholarly journals High serum potassium level is associated with successful electrical cardioversion for new-onset atrial fibrillation in the intensive care unit: A retrospective observational study

2019 ◽  
Vol 47 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Michihito Kyo ◽  
Koji Hosokawa ◽  
Shinichiro Ohshimo ◽  
Yoshiko Kida ◽  
Yuko Tanabe ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Serum Potassium ◽  
Potassium Level ◽  
Serum Potassium Level ◽  
High Serum ◽  
Factors Associated ◽  
Icu Discharge ◽  
Onset Atrial Fibrillation ◽  
New Onset

Electrical cardioversion (ECV) is a potentially life-saving treatment for haemodynamically unstable new-onset atrial fibrillation (AF); however, its efficacy is unsatisfactory. We aimed to elucidate the factors associated with successful ECV and prognosis in patients with AF. This retrospective observational study was conducted in two mixed intensive care units (ICUs) in a university hospital. Patients with new-onset AF who received ECV in the ICU were enrolled. We defined an ECV session as consecutive shocks within 15 minutes. The success of ECV was evaluated five minutes after the session. We analysed the factors associated with successful ECV and ICU mortality. Eighty-five AF patients who received ECV were included. ECV was successful in 41 (48%) patients, and 11 patients (13%) maintained sinus rhythm until ICU discharge. A serum potassium level ≥3.8 mol/L was independently associated with successful ECV in multivariate analysis (odds ratio (OR), 3.13; 95% confidence interval (CI), 1.07–9.11; p = 0.04). Maintenance of sinus rhythm until ICU discharge was significantly associated with ICU survival (OR 9.35; 95% CI 1.02–85.78, p = 0.048). ECV was successful in 48% of patients with new-onset AF developed in the ICU. A serum potassium level ≥3.8 mol/L was independently associated with successful ECV, and sinus rhythm maintained until ICU discharge was independently associated with ICU survival. These results suggested that maintaining a high serum potassium level may be important when considering the effectiveness of ECV for AF in the ICU.

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