Antazoline for termination of atrial fibrillation during the procedure of pulmonary veins isolation

Comparative effectiveness and safety of antazoline‑based and propafenone‑based strategies for pharmacological cardioversion of short‑duration atrial fibrillation in the emergency department

“…Well -known mild adverse effects of antazoline such as hot flush, metallic taste, or drowsiness were not consistently reported in medical documentation and therefore were not analyzed in this study. 8,10,12,15 An interesting finding of the study was a relatively high proportion of patients with documented CAD or structural heart disease in the antazoline group (TABLE 1). Propafenone had been administered more reluctantly in those patients, which is understandable in the light of clinical guidelines.…”

“…Antazoline was reported to have a rapid onset of action and times to conversion ranging between 7 and 20 minutes, while the effectiveness of propafenone might improve with time. 4,5,[10][11][12] To set the study within a time perspective, the average time of stay among 199 patients with AF treated in our ED in 2015 was 180.5 ±105.2 minutes (range, 10-627 minutes); median, 161 minutes (IQR, 110; 235].…”

“…2,3 Patients with structural heart disease were included or excluded from the previous antazoline studies depending on the publication: for instance, structural heart disease was an exclusion criterion in the AnPAF trial. 8,10,12,16 The general effectiveness and safety of antazoline in those groups of patients remain unclear and warrant further research.…”

“…In human healthy volunteers, the terminal elimination half -life of antazoline was 2.29 hours with a mean residence time of 3.45 hours and no data on hemodynamic effects of antazoline yet published. 9 In clinical practice, the drug can be administered intravenously in boluses of 50 to 100 mg every 3 to 5 minutes until successful cardioversion or up to a cumulative dose of 250 to 350 mg. [10][11][12] While not mentioned in relevant clinical guidelines, published observational studies have suggested high efficacy of antazoline, ranging between 50% and 80% and a rapid onset of action with cardioversion times between 7 and 20 minutes. 8,[10][11][12][13][14][15] However, there have been no studies examining the comparative effectiveness and safety of antazoline and antiarrhythmic drugs recommended by clinical guidelines.…”

“…9 In clinical practice, the drug can be administered intravenously in boluses of 50 to 100 mg every 3 to 5 minutes until successful cardioversion or up to a cumulative dose of 250 to 350 mg. [10][11][12] While not mentioned in relevant clinical guidelines, published observational studies have suggested high efficacy of antazoline, ranging between 50% and 80% and a rapid onset of action with cardioversion times between 7 and 20 minutes. 8,[10][11][12][13][14][15] However, there have been no studies examining the comparative effectiveness and safety of antazoline and antiarrhythmic drugs recommended by clinical guidelines. 2,3 The aim of the study was to examine the comparative effectiveness and safety of antazoline--based and propafenone -based strategies for a pharmacological cardioversion of short -duration AF in the emergency department of our center.…”