scholarly journals Cinderella drug: an antazoline is effective in pharmacological cardioversion of atrial fibrillation - Single center experience

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Miskowiec ◽  
T Dembowski ◽  
E Cwiek-Rebowska ◽  
HD Qawoq ◽  
P Zycinski ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Roc Curves ◽  
Persistent Atrial Fibrillation ◽  
Antiarrhythmic Effect ◽  
Published Data ◽  
Single Center ◽  
Multivariable Logistic Regression Model ◽  
Duration Time ◽  
Pharmacological Cardioversion

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Antazoline (ANT) is an old antihistaminic medication with antiarrhythmic properties. After intravenous administration ANT exerts rapid antiarrhythmic effect often resulting in conversion of persistent atrial fibrillation (AF) to sinus rhythm (SR). However, published data on its effectiveness, safety and  clinical utility for rapid AF termination are limited and ANT is not recognized as a cardioversion drug.  Aim To assess the real-world efficacy of ANT for pharmacological cardioversion of paroxysmal and persistent non-valvular AF.  Methods We conducted a single center, retrospective, observational study including patients (pts) with history paroxysmal or persistent AF episode lasting less than 6 months, in stable cardiopulmonary condition who were qualified for elective pharmacological cardioversion with intravenous ANT. The primary end-point was the conversion of AF to SR confirmed in electrocardiography (ECG) during the 6-hours observation.  Results A total of 176 pts (mean age 68.4 ± 12.0 years, 49% male) were enrolled into the study. In 93 patients (52%) AF duration was shorter than 48 hours and median AF duration time was 24 (7 – 432) hours. The overall success rate of pharmacological cardioversion of AF with intravenous ANT was 45.5% (80/176 pts). The mean used dose of ANT was 250.9 ± 65.4mg. The subgroup analysis, regarding the AF duration, suggested the effectiveness of ANT mainly in in short-lasting AF (effectiveness of antazoline based cardioversion for AF lasting <48h vs others:  75.3% vs 12.0%,  p < 0.001). In multivariable logistic regression model AF duration (for every 24h in AF - OR = 0.97; 95% CI 0.96 – 0.98), the left atrium antero-posterior diameter (OR = 0.92; 95% CI 0.86 – 0.99) and the serum creatinine level (OR = 0.15; 95% CI 0.03 – 0.73) were identified as  independent predictors of antazoline based pharmacological cardioversion effectiveness, even after adjustment for comorbidities. The ROC curves revealed that the optimal cut-off value for AF duration time predicting ANT’s effectiveness was 48h (AUC = 0.876; 95% CI 0.815 – 0.922). There were only one episode of bradycardia <45 bpm related to ANT administration.  Conclusions Intravenous antazoline administration is effective and safe in rapid pharmacological cardioversion of paroxysmal AF, especially in the short-lasting AF (<48 hours) and in patients without the left atrium enlargement and significant renal disease. Abstract Figure.

scholarly journals The reinvented old player – an antazoline is effective in pharmacological cardioversion of atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Miskowiec ◽  
T Dembowski ◽  
E Cwiek-Rebowska ◽  
H D Qawoq ◽  
P Zycinski ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Roc Curves ◽  
Antiarrhythmic Effect ◽  
Published Data ◽  
Roc Curve Analysis ◽  
Multivariable Logistic Regression Model ◽  
Funding Sources ◽  
Duration Time ◽  
Pharmacological Cardioversion

Abstract Introduction Antazoline (ANT) is an old antihistaminic medication with antiarrhythmic properties. After intravenous administration ANT exerts rapid antiarrhythmic effect often resulting in conversion of atrial fibrillation (AF) to sinus rhythm (SR) and is widely used in Poland for this purpose in the last years. However, published data on its effectiveness, safety and clinical utility for rapid AF termination are limited and ANT is not recognized as a cardioversion drug. Aim To assess the real-world efficacy of ANT for pharmacological cardioversion of paroxysmal and persistent non-valvular AF. Methods Our single center, retrospective, observational study included patients (pts) with history paroxysmal or persistent AF episode lasting less than 6 months, in stable cardiopulmonary condition who were qualified for elective pharmacological cardioversion with intravenous ANT. The primary end-point was the conversion of AF to SR confirmed in electrocardiography (ECG) during the 6-hours observation. Results A total of 176 pts (mean age 68.4±12.0 years, 49% male) were enrolled into the study. In 93 patients (52%) AF duration was shorter than 48 hours and median AF duration time was 24 (7–432) hours. The overall success rate of pharmacological cardioversion of AF with intravenous ANT was 45.5% (80/176 pts). The mean used dose of ANT was 250.9±65.4mg. The subgroup analysis, regarding the AF duration, suggested the effectiveness of ANT mainly in in short-lasting AF (effectiveness of antazoline based cardioversion for AF lasting <48h vs others: 75.3% vs 12.0%, p<0.001). In multivariable logistic regression model AF duration (for every 24h in AF – OR=0.97; 95% CI 0.96–0.98), the left atrium antero-posterior diameter (OR=0.92; 95% CI 0.86–0.99) and the serum creatinine level (OR=0.15; 95% CI 0.03–0.73) were identified as independent predictors of antazoline based pharmacological cardioversion effectiveness, even after adjustment for comorbidities. The ROC curves revealed that the optimal cut-off value for AF duration time predicting ANT's effectiveness was 48h (AUC=0.876; 95% CI 0.815–0.922) – Figure 1. There were only one episode of bradycardia <45 bpm related to ANT administration. Conclusions Antazoline is effective and safe in rapid pharmacological cardioversion of paroxysmal AF, especially in the short-lasting AF (<48 hours) and in patients without the left atrium enlargement and significant renal disease. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. ROC curve analysis

scholarly journals Pre-Procedural Prediction of Termination of Persistent Atrial Fibrillation by Catheter Ablation as an Indicator of Reverse Remodeling of the Left Atrium

2013 ◽  
Vol 77 (6) ◽  
pp. 1416-1423 ◽  
Author(s):  
Koji Kumagai ◽  
Tamotsu Sakamoto ◽  
Keijiro Nakamura ◽  
Mamoru Hayano ◽  
Eiji Yamashita ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Persistent Atrial Fibrillation ◽  
Reverse Remodeling

scholarly journals P330Reverse remodelling of the left atrium occurs early after catheter ablation for persistent atrial fibrillation

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii55-iii55
Author(s):  
B. Maille ◽  
A. Hussein ◽  
V. Chaturvedi ◽  
M. Morgan ◽  
C. Ronayne ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Persistent Atrial Fibrillation

scholarly journals P842Outcome following thoracoscopic epicardial ablation of patients with persistent atrial fibrillation or with severe left atrium dilatation

EP Europace ◽  
2018 ◽  
Vol 20 (suppl_1) ◽  
pp. i156-i156
Author(s):  
M Cireddu ◽  
L Foppoli ◽  
C Bisceglia ◽  
F Baratto ◽  
C M Barbaro ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Persistent Atrial Fibrillation ◽  
Epicardial Ablation

Incidence and predictors of left atrium thrombus in acute ischemic stroke patients without atrial fibrillation: a single center cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Cinar ◽  
M.I Hayiroglu ◽  
V Cicek ◽  
S Asal ◽  
M.M Atmaca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Left Atrium ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
Single Center ◽  
Stroke Patients ◽  
Previous Diagnosis

Abstract Introduction The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE). Material and methods In this single center, retrospective cohort study, we enrolled 149 consecutive acute ischemic stroke patients. All of the patients underwent TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT. Results Among all cases, 14 patients (9.3%) had a diagnosis of LAT on TEE examination. In a multivariate analysis; a previous diagnosis of cerebrovascular accident, elevated mean platelet volume (MPV), low left ventricle ejection fraction (EF) and a reduced left atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area of MPV under the receiver operating characteristic curve analysis was 0.70 (95% CI: 0.57–0.83; p=0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT. Conclusion Patients with low ventricle EF and elevated MPV should undergo further TEE examination for the possibility of cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in acute ischemic stroke patients without AF. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Hot balloon ablation of persistent atrial fibrillation with a dilated left atrium in a case of dilated cardiomyopathy

2017 ◽  
Vol 4 (2) ◽  
pp. 28
Author(s):  
Ayako Okada ◽  
Morio Shoda ◽  
Takahiro Takeuchi ◽  
Ken Kato ◽  
Wataru Shoin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Dilated Cardiomyopathy ◽  
Left Atrium ◽  
Persistent Atrial Fibrillation ◽  
Left Ventricular Ejection ◽  
Lv Dysfunction ◽  
Intravenous Drip ◽  
Balloon Ablation

A 70-year-old man who developed dilated cardiomyopathy with persistent atrial fibrillation (PSAF) was admitted to our hospital. He was already drug-resistant. The left atrium (LA) was severely enlarged. The left ventricular ejection fraction (LVEF) was 39%, and contraction was severely reduced. For AF ablation, catheter ablation (CA) was used for mild to moderate LV dysfunction without severe left atrial dilatation. In severe LV dysfunction, excessive intravenous drip volume may precipitate congestive heart failure. On the other hand, shorter isolation time has been reported with balloon ablation as compared to CA. Therefore, the intravenous drip volume is small. We planned to use the balloon technique for a patient with LA dilatation and severe LV dysfunction despite another hospital not having done so. After the procedure, the pulmonary veins were successfully isolated, and congestive heart failure recovered after sinus rhythm termination. There was no recurrence of AF after the procedure. Hot balloon ablation can be effective for PSAF with severe heart failure.

scholarly journals Modulation of SERCA in Patients with Persistent Atrial Fibrillation Treated by Epicardial Thoracoscopic Ablation: The CAMAF Study

2020 ◽  
Vol 9 (2) ◽  
pp. 544 ◽  
Author(s):  
Celestino Sardu ◽  
Gaetano Santulli ◽  
Germano Guerra ◽  
Maria Consiglia Trotta ◽  
Matteo Santamaria ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Persistent Atrial Fibrillation ◽  
Epicardial Ablation ◽  
Multicenter Observational Study ◽  
Endoplasmic Reticulum Calcium ◽  
One Year ◽  
Left Atrium Volume ◽  
First Time ◽  
Af Recurrence

Objectives: To evaluate atrial fibrillation (AF) recurrence and Sarcoplasmic Endoplasmic Reticulum Calcium ATPase (SERCA) levels in patients treated by epicardial thoracoscopic ablation for persistent AF. Background: Reduced levels of SERCA have been reported in the peripheral blood cells of patients with AF. We hypothesize that SERCA levels can predict the response to epicardial ablation. Methods: We designed a prospective, multicenter, observational study to recruit, from October 2014 to June 2016, patients with persistent AF receiving an epicardial thoracoscopic pulmonary vein isolation. Results: We enrolled 27 patients. Responders (n = 15) did not present AF recurrence after epicardial ablation at one-year follow-up; these patients displayed a marked remodeling of the left atrium, with a significant reduction of inflammatory cytokines, B type natriuretic peptide (BNP), and increased levels of SERCA compared to baseline and to nonresponders (p < 0.05). Furthermore, mean AF duration (Heart rate (HR) 1.235 (1.037–1.471), p < 0.05), Left atrium volume (LAV) (HR 1.755 (1.126–2.738), p < 0.05), BNP (HR 1.945 (1.895–1.999), p < 0.05), and SERCA (HR 1.763 (1.167–2.663), p < 0.05) were predictive of AF recurrence. Conclusions: Our data indicate for the first time that baseline values of SERCA in patients with persistent AF might be predictive of failure to epicardial ablative approach. Intriguingly, epicardial ablation was associated with increased levels of SERCA in responders. Therefore, SERCA might be an innovative therapeutic target to improve the response to epicardial ablative treatments.

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