Safety and Efficacy of Ibutilide for Acute Pharmacological Cardioversion of Rheumatic Atrial Fibrillation

Cardiology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Jayaprakash Shenthar ◽  
Bharatraj Banavalikar ◽  
Sanjai Pattu Valappil ◽  
Saurabh Deshpande ◽  
Aparna Nireshwalia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Torsades De Pointes ◽  
Careful Monitoring ◽  
Nonvalvular Atrial Fibrillation ◽  
Serious Adverse Event ◽  
End Point ◽  
Conversion Time ◽  
The Mean ◽  
Pharmacological Cardioversion

<b><i>Introduction:</i></b> Ibutilide is indicated for acute cardioversion of nonvalvular atrial fibrillation (AF). However, its efficacy and safety in the pharmacological cardioversion of rheumatic AF are unknown. <b><i>Methods:</i></b> Patients with mild-to-moderate rheumatic mitral valve (MV) disease with symptomatic, paroxysmal, or persistent AF were included in the analysis. Intravenous ibutilide was administered at doses tailored to body weight (0.5–2.0 mg) for over 10 min. The primary end point was efficacy, assessed as the rate of conversion of AF to sinus rhythm. The secondary end point was safety, including arrhythmic events and death within 24 h of drug initiation. <b><i>Results:</i></b> From June 2016 to October 2018, 165 patients (94 with mitral stenosis, 23 with mitral regurgitation, 11 with mixed MV disease, and 37 with MV replacement) received ibutilide (mean dose 0.90 ± 0.54 mg). Ibutilide successfully converted AF to sinus rhythm in 127/165 (76.9%) patients, with a conversion time of 7.9 ± 4.1 min. The QTc increased from 419.9 ± 15.8 to 487.5 ± 34 ms after ibutilide administration (<i>p</i> &#x3c; 0.001). The mean change in QTc after ibutilide administration (∆QTc) was 72.01 ± 36.03. There were no deaths, but 3 patients (1.8%) developed torsades de pointes (TdP) requiring defibrillation 55 ± 37 min after infusion. <b><i>Conclusion:</i></b> Ibutilide cardioverted 77% of rheumatic AF to sinus rhythm, indicating its potential as a clinically useful option for pharmacological cardioversion of rheumatic AF. TdP is a potentially serious adverse event that requires careful monitoring.

Detection of a Hypercoagulable State in Nonvalvular Atrial Fibrillation and the Effect of Anticoagulant Therapy

1996 ◽  
Vol 75 (02) ◽  
pp. 219-223 ◽  
Author(s):  
Rolf Mitusch ◽  
Hans J Slemens ◽  
Michael Garbe ◽  
Thomas Wagner ◽  
Abdolhamid Sheikhzadeh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Anticoagulant Therapy ◽  
Initial Study ◽  
Hypercoagulable State ◽  
Tissue Type ◽  
Nonvalvular Atrial Fibrillation ◽  
Type Plasminogen Activator ◽  
Intravenous Heparin ◽  
Thrombin Antithrombin Iii Complex

SummaryThe purpose of the study was to evaluate alterations of the hemostatic system and the effect of anticoagulant therapy in nonvalvular atrial fibrillation. A set of molecular hematologic markers was measured prospectively in 69 patients with atrial fibrillation and 28 age-matched patients in sinus rhythm. Significantly elevated levels of thrombin-antithrombin III complex (8.5 ± 1.6 vs. 2.5 ± 0.3 αg/1; p <0.001), fibrin monomers (27.1 ± 3.2 vs. 13.4 ± 3.7 nM; p <0.001), D-dimers (788 ± 76 vs. 405 ± 46 αg/l; p <0.005), and tissue-type plasminogen activator (9.6 ± 0.5 vs. 7.2 ± 0.5 αg/l; p <0.05) were observed in patients with atrial fibrillation compared to those in sinus rhythm. In a subgroup of patients in whom anticoagulant therapy with oral coumadin or standard intravenous heparin was established after the initial study, hemostatic activation decreased significantly. In conclusion, molecular hematologic markers indicate a hypercoagulable state in atrial fibrillation which may characterize a group of patients at elevated risk for thromboembolic disease.

scholarly journals MEDICATION FOR PHARMACOLOGICAL CARDIOVERSION OF PAROXYSMAL ATRIAL FIBRILLATION AT THE PREHOSPITAL STAGE: STUDY OF EFFICACY AND SAFETY

2018 ◽  
Vol 18 (4) ◽  
pp. 43-47
Author(s):  
I. Y. Lukianova ◽  
A. V. Kuzneztov ◽  
V. M. Komarnitzkii ◽  
A. G. Kozyreva
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Paroxysmal Atrial Fibrillation ◽  
Efficacy And Safety ◽  
Pharmacological Cardioversion

This study demonstrates the effectiveness of procainamide, propafenone and amiodaronefor pharmacological cardioversion in patients with paroxysmal atrial fibrillation. The restoration of the sinus rhythm within 60 minutes was observed for propafenone 73,2%, for procainamide 55,00% and for amiodarone 16,13% of cases.

P373Arterial stiffness changes in patients with obesity and atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Tarzimanova ◽  
V I Podzolkov ◽  
A E Bragina ◽  
M V Pisarev ◽  
R G Gataulin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Arterial Stiffness ◽  
Sinus Rhythm ◽  
Body Mass ◽  
Paroxysmal Atrial Fibrillation ◽  
Obese Patients ◽  
Waist To Hip Ratio ◽  
Group I ◽  
The Mean

Abstract Objective To study the changes in arterial stiffness in patients with obesity and paroxysmal atrial fibrillation (AF). Materials and methods The study included 82 obese patients. Forty-two of them (group I) had paroxysmal AF, their mean age was 60.9 ± 6.2 years. The control group (group II) included 40 obese patients in sinus rhythm with the mean age of 57.2 ± 6.5 years.  We studied arterial stiffness using cardio-ankle vascular index (CAVI) measured by the VaSera device (VS-1000) in all the patients. Patients from group I were evaluated after 3 days of sinus rhythm restoration and maintenance. We also measured the anthropometric indicators which included body mass index, waist circumference, abdominal sagittal diameter, waist-to-hip and waist-to-height ratios. Results There were no significant differences in body mass index between 2 groups. The waist-to-hip ratio was significantly higher in patients with obesity and paroxysmal atrial fibrillation than in obese patients in sinus rhythm and was 1.37 ± 0.09 and 0.84 ± 0.06, respectively (p = 0.002). The mean value of CAVI was 9.61 ± 1.51 and 6.42 ± 0.18 in group I and group II respectively; this difference was significant (p = 0.001). There was a strong positive correlation between CAVI and waist-to-hip ratio in the group I patients (p = 0.02). The results show that vascular stiffness is significantly higher in obesity patients with paroxysmal form AF. Conclusion Positive correlations between increased arterial stiffness and anthropometric indicators confirm the role of visceral obesity in the development of AF.

P204 Recovery of left atrial function after restoration of sinus rhythm in patients with atrial fibrillation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Kupczynska ◽  
B Michalski ◽  
D Miskowiec ◽  
P Wejner-Mik ◽  
K Wierzbowska-Drabik ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Mechanical Function ◽  
Rr Interval ◽  
Mitral Annular Velocity ◽  
The Mean ◽  
Lv Ejection Fraction ◽  
Early Filling

Abstract Background Atrial fibrillation (AF) is associated with impaired mechanical function of the atria. The restoration of sinus rhythm (SR) leads to improvement of mechanics, however the onset of those changes is not established yet. Purpose To analyse changes in left atrial (LA) mechanical function after conversion to SR. Methods Forty patients (mean age 65 ± 12 years, 63% male) with nonvalvular AF underwent successful electrical cardioversion. Transthoracic echocardiography with speckle tracking analysis (STE) of LA was performed in AF and within 24 hours after cardioversion, in SR. We analysed standard parameters of left ventricle (LV) and LA. By the use of STE we assessed peak atrial longitudinal strain (PALS), time to PALS indexed to RR interval (TT-PALS/RR) and intra-atrial asynchrony. Results Heart rate during echocardiography was higher before cardioversion - median (IQR) 90 beats per minute (80-110) vs 61 (56-72); p &lt; 0.0001. The mean LV ejection fraction in our study group was 48 ± 11%. We noticed significant improvement in LA STE measurements and in early diastolic (E’) mitral annular velocity. There were no significant changes in systolic (S’) mitral annular velocity and in the ratio of transmitral Doppler early filling velocity to E’ (E/E’). Detailed results are present in the table. Conclusions Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR. Atrial fibrillation Sinus rhythm p S" (cm/s) 6 (5-6.5) 6 (5-6.6) NS E" (cm/s) 10 (7.5-13) 9.5 (6.8-10.5) 0.0008 E/E" 8.2 (6.3-12.3) 9.3 (7.5-13) NS PALS (%) 9.9 ± 4.6 14.5 ± 6 &lt;0.0001 TTP-PALS/RR (%) 51 (44-58) 42 (38-45) 0.0001 LA asynchrony 15 (11-19) 9 (8-14) 0.0007

scholarly journals Vernakalant for Rapid Cardioversion of Recent-Onset Atrial Fibrillation: Results from the SPECTRUM Study

2020 ◽  
Author(s):  
Samuel Lévy ◽  
Juha Hartikainen ◽  
Beate Ritz ◽  
Tord Juhlin ◽  
José Carbajosa-Dalmau ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Observational Study ◽  
Sinus Rhythm ◽  
Conversion Rate ◽  
Daily Practice ◽  
Serious Adverse Events ◽  
Multicenter Observational Study ◽  
Recent Onset ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation

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.

scholarly journals Experience of pharmacological cardioversion with refralon in persistent atrial fibrillation and flutter according to the data of the cardiology department of Orenburg regional clinical hospital

2021 ◽  
Vol 28 (3) ◽  
pp. 13-20
Author(s):  
L. K. Kozlova ◽  
N. V. Sokolova ◽  
A. V. Sivkova ◽  
A. E. Kamyshanova ◽  
O. Y. Abramova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Total Dose ◽  
Left Atrium ◽  
Persistent Atrial Fibrillation ◽  
Clinical Hospital ◽  
The Third ◽  
Cardiology Department ◽  
The Mean ◽  
Medical Histories

Aim. To assess the effectiveness and safety of refralon based cardioversion on the experience of the cardiology department of Orenburg Regional Clinical Hospital.Methods. The archival medical histories of 14 patients with persistent atrial fibrillation (AF) and 2 patients with persistent atrial flutter (AFL) (overall 16 patients), who underwent an attempt to restore sinus rhythm with refralon, were analyzed. The mean age of the patients was 51.7±10.4 years. The mean duration of AF/AFL since its last detection was 8.0±6.5 weeks (from 8 days to 8 months). Fifteen patients had hypertension, 3 of them had coronary artery disease (CAD), and 1 patient had CAD with type 2 diabetes mellitus. One of the patients had lone AF. Before cardioversion, all patients underwent the following examination: clinical and biochemical blood tests, clinical urine tests, electrocardiography (ECG), echocardiography (Echo), transesophageal Echo, Holter ECG, the determination of the level of thyroid-stimulating hormone, thyroxine, electrolytes, including potassium and magnesium.Results. According to Echo, initially, the transverse size of the left atrium in patients was 4.3±0.3 cm. Its increase was noted in 68.7% of patients (from 4.3 to 5.0 cm). Restoration of sinus rhythm after the first step of refralon administration at a dose of 10 μg/kg was achieved in 8 patients, after the second step of administration (total dose 20 μg/kg) - in 5 patients and after the third step (total dose 30 μg/kg) - in 2 patients. In 1 patient, restoration of sinus rhythm was not achieved after the administration of the third bolus. Out of 15 patients with restored sinus rhythm, AF recurrence occurred in three. In one of the patients with successful cardioversion, the sinus rhythm was restored the next day. The duration of the last episode of AF and the size of the left atrium did not significantly affect the effectiveness of cardioversion and amounted to 62±54 days and 4.3±0.35 cm, respectively, in patients with successful cardioversion, and with a recurrence of AF - 34.3±28 days and 4.2±0.35 cm (p=0.2; р=0.6). The efficacy of cardioversion with refralon was 71.4% in patients with AF, and 100% in patients with AFL. No adverse events of refralon were found in patients.Conclusion. At the time of discharge, sinus rhythm was recorded in 12 out of 16 patients (75%). The ineffectiveness of cardioversion with refralon was noted only in patients with AF; in all patients with AFL the sinus rhythm was restored.

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.

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 &lt;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&lt;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&lt;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

219A machine learning classification algorithm to detect patients with paroxysmal atrial fibrillation during sinus rhythm

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
D Tachmatzidis ◽  
D Filos ◽  
I Chouvarda ◽  
D Mouselimis ◽  
A Tsarouchas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
P Wave ◽  
Support Vector ◽  
Svm Classifier ◽  
P Waves ◽  
Machine Learning Classification ◽  
Increased Risk ◽  
Wave Morphology ◽  
The Mean

Abstract Background Atrial fibrillation (AF) - the most common sustained cardiac arrhythmia - while not a life-threatening condition itself, leads to an increased risk of stroke and high rates of mortality. Early detection and diagnosis of AF is a critical issue for all health stakeholders. Purpose The aim of this study is to identify P-wave morphology patterns encountered in patients with Paroxysmal AF (PAF) and to develop a classifier discriminating PAF patients from healthy volunteers. Methods Three-dimensional 1000Hz ECG signals of 5 minutes duration were obtained through the use of a Galix GBI-3S Holter monitor from a total of 68 PAF patients and 52 healthy individuals. Signal pre-processing, consisting of denoising, QRS auto-detection, and ectopic beats removal was performed and a signal window of 250ms prior to the Q-wave (Pseg) was considered for every single beat. P‑wave morphology analysis based on the dynamic application of the k‑means clustering process was performed. For those Pseg that were assigned in the largest cluster, the mean P-wave was computed. The correlation of every P-wave with the mean P-wave of the main cluster was calculated. In case that it exceeded a prespecified threshold, the P-wave was allocated to the main morphology. For the remaining P‑waves, the same approach was followed once again, and the secondary morphology was extracted (picture). The P-waves of the dominant morphology were further analyzed using wavelet transform, whereas time-domain characteristics were also extracted. A Support Vector Machine (SVM) model was created using the Gaussian Radial Basis Function kernel and the forward feature selection wrapper approach was followed. ECGs were allocated to the training, internal validation, and testing datasets in a 3:1:1 ratio. Results The percentage of P-waves following the main morphology in all three leads was lower in PAF patients (91.2 ±7.3%) than in healthy subjects (96.1 ±3.5%, p = 0.02). Classification between the two groups highlighted 7 features, while the SVM classifier resulted in a balanced accuracy of 91.4 ± 0.2% (sensitivity 94.2 ± 0.3%, specificity 88.6 ± 0.1%) Conclusion An Artificial Intelligence based ECG Classifier can efficiently identify PAF patients during normal sinus rhythm. Abstract Figure.

Sign in / Sign up

Export Citation Format

Share Document