Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation

Lafuente-Lafuente, Carmelo; Mouly, Stéphane; Longas-Tejero, MA; Bergmann, Jean‐François

doi:10.1002/14651858.cd005049

Cited by 68 publications

(114 citation statements)

References 22 publications

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“…Switching antiarrhythmic therapy is relatively common in AF patients; the majority does so for a documented lack of efficacy (35%-63%, according to different study drugs and populations). 9,22 In addition, most of the AADs currently recommended for rhythm control are burdened by poor tolerability and a plethora of side effects. 23 A recent meta-analysis 9 showed that class Ic AADs and sotalol were often withdrawn due to AEs, with a number needed to harm (NNH) of 17 to 36; whereas all AADs, except amiodarone and propafenone, had clinical proarrhythmic effects (NNH, [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…8 Patients treated with AADs, including class I agents, sotalol, and amiodarone, have an annual AF recurrence rate of 43% to 67%. 9 The use of these drugs is also associated with serious side effects such as thyroid and pulmonary toxicity 10 and proarrhythmic effects, 11 which together with poor tolerability profile, can lead to discontinuation rates as high as 46% for propafenone or sotalol and 34% with amiodarone during a 16-month follow-up. 12 Therefore, the majority of patients who experience a recurrence of AF or have tolerability issues usually stop the drug to seek therapeutic alternatives.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Dronedarone in Patients Previously Treated With Other Antiarrhythmic Agents

Guerra

Hohnloser

Kowey³

et al. 2014

Clinical Cardiology

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Background: Currently available antiarrhythmic drugs (AADs) for the prevention of atrial fibrillation (AF)/atrial flutter (AFL) suffer from incomplete efficacy and poor tolerability. In patients previously treated with a class Ic agent, dronedarone decreased the risk of recurrence by 31.4% (HR: 0.69; 95% CI: 0.53-0.89; P = 0.004), whereas in patients previously treated with sotalol, dronedarone showed a trend toward a decrease of risk of recurrence (HR: 0.86; 95% CI: 0.67-1.11; P = 0.244). Dronedarone was equally effective irrespective of whether class Ic or sotalol were stopped for lack of efficacy or adverse events (AEs). Discontinuation rates were similar in the 2 groups (55.9% vs 43.1%), as were incidence of AEs and serious AEs. Conclusions: Dronedarone seems to be effective in preventing AF recurrences in patients without permanent AF previously treated with other AADs, even if those were discontinued for lack of efficacy. Dronedarone appears to be well tolerated even in patients who already had tolerability issues with AADs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Dronedarone in Patients Previously Treated With Other Antiarrhythmic Agents

Guerra

Hohnloser

Kowey³

et al. 2014

Clinical Cardiology

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“…There is a large body of research detailing medication for maintaining SR following ECV, with a Cochrane review outlining the current trends . Overall, amiodarone, sotalol, ibutilide, aprindine, vernakalant, flecainide, and propafenone are proven to improve outcomes following ECV (Table ).…”

Section: Af and Patient Factorsmentioning

confidence: 99%

“…Although the underlying mechanism is not fully understood, these drugs should not be used in patients with ischemic heart disease or other serious structural heart disease . Both drugs only show limited efficiency in persistent AF but are effective in preventing recurrence of AF after successful ECV …”

Section: Af and Patient Factorsmentioning

confidence: 99%

A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation

Ecker

Knoery

Rushworth

et al. 2018

Clinical Cardiology

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Atrial fibrillation is the most common heart-rhythm disorder, affecting about 1.5% to 2% of the population with an increased risk of mortality and morbidity due to stroke, thromboembolism, and heart failure. If the conversion back to sinus rhythm does not happen spontaneously, pharmacological or electrical cardioversion (ECV) is the next available treatment options for some patients. However, the long-term success following ECV is variable. This review describes the factors that are associated with maintenance of sinus rhythm following ECV and proposes a clinical strategy based on the available evidence.Atrial fibrillation (AF) is a supraventricular arrhythmia characterized by extremely rapid and uncoordinated electrical activity in the atria with variable conduction through the atrioventricular node, resulting in irregular, and often rapid, ventricular contraction. AF is the most common sustained heart-rhythm disorder in the developed world, found in 1% to 2% of the general population, with a higher prevalence in females and older patients.1 Because of an aging population, it is likely that AF patient numbers will continue to rise, along with associated increases in healthcare costs. 2 Palpitations, breathlessness, fatigue, and reduced exercise tolerance are AF-associated symptoms, and there is an increased risk of stroke with AF, with the need for anticoagulation. 2In some patients, AF will be permanent and therapy is aimed at controlling the ventricular rate (rate-control strategy). In other patients, normal rhythm initially can be restored with pharmacological or electrical cardioversion (ECV) but often requires additional strategies to maintain sinus rhythm (SR; rhythm-control strategy).There is no convincing mortality benefit to achieving rhythm control over rate control; therefore, treatment decisions are usually based on the presence of symptoms and the perceived likelihood of successful cardioversion. Cardioversion can be achieved by pharmacological methods or ECV; however, maintenance of SR may only be temporary. [3][4][5][6][7] The use of ECV may be indicated where pharmacological rhythm-control strategies have failed and the patient remains symptomatic. Patient selection is important, as the maintenance of longterm SR can be difficult. The advantages of ECV are that it is associated with a high initial success rate (68%-98%) 8 ; however, it requires sedation or general anesthesia, and although initially successful, longterm maintenance of SR is not reliably achieved. 9 AF relapse following ECV is also associated with increased mortality, 10 thus highlighting the importance of identifying the correct patient group for cardioversion and, where possible, addressing reversible factors associated with poorer outcomes. Furthermore, it is crucial at the time of ECV that patients are appropriately prepared with adequate hydration and correction of any electrolyte abnormalities. ECV should also be avoided in stable patients with concurrent infection or significant inflammation.Many factors have been reported ...

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“…This is best illustrated by the fact that some of the drugs which markedly prolong the QT interval and inhibit I Kr carry a lower potential for torsades de pointes than others with the same potential for QT prolongation, e.g. when sotalol [37] is compared to amiodarone or dronedarone [38–41].…”

Section: Reduced Repolarization Reserve Measurable As Excessive Qt Pmentioning

confidence: 99%

Predictable and Less Predictable Unwanted Cardiac Drugs Effects: Individual Pre‐Disposition and Transient Precipitating Factors

Fabritz

Kirchhof

2010

Basic Clin Pharma Tox

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In addition to their therapeutic effect, all drugs have unwanted effects. For the purpose of this MiniReview, unwanted drug effects will be discussed as either predictable, dose-dependent effects, or as less predictable events which only occur in patients pre-disposed to unwanted drug reactions when confronted with specific situations. While clinicians have long been using biomarkers to identify patients prone to less predictable unwanted drug effects, emerging data clearly suggest that such effects are often a consequence of interactions between drug effects, drug metabolism, an individual, at times genetically conferred pre-disposition to the interaction, and transient pre-disposing factors. This paper describes general principles of predictable and less predictable unwanted drug effects and discusses the complex interplay of genetic and acquired pre-disposing and precipitating factors for such effects using the example of ventricular pro-dysrhythmia. The latter, an important unwanted effect of many drugs, is a common yet not fully understood less predictable cardiac drug effect. Understanding the mechanisms of ventricular pro-dysrhythmia may allow to predict this unwanted drug effect better, and to identify novel markers for such events in the future.Unwanted drug effects have long been recognized as an important medical problem [1]. Among the first recognized unwanted drug effects were aplasia induced by chloramphenicol and inhibition of normal foetal development by thalidomide [1]. These effects were either observed by physicians who prescribed the drugs (chloramphenicol) or by epidemiological observations in regions in which these drugs were freely available (thalidomide). The recognition of these effects has resulted in control mechanisms to detect such unwanted drug effects that have been instituted both before approval of a new drug and after approval ('postmarketing surveillance'). In parallel, systematic pre-clinical testing for unwanted drug effects became standard for the development of new drugs. Especially the 'post marketing surveillance' mechanisms initiated in the aftermath of the recognition of the first severe unwanted effects, such as nationwide reporting of adverse events to central bodies and review of medical literature for unwanted effects, have helped to identify, characterize and understand unwanted drug effects. Table 1 gives a list of the first unwanted effects that were observed by such mechanisms. The mechanisms initiated at that time were sensitive enough to detect relatively common, often dose-related unwanted effects. Our understanding of the pathophysiological mechanisms that provoke these unwanted drug effects has rendered most of these effects predictable.For the purpose of this MiniReview, unwanted drug effects will be discussed as predictable effects, i.e. drug effects that are detectable in the majority of patients and volunteers and often associate with inappropriate drug dosing; and less predictable effects, i.e. rare drug effects that will only occur in suscep...

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Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation

Cited by 68 publications

References 22 publications

Efficacy and Safety of Dronedarone in Patients Previously Treated With Other Antiarrhythmic Agents

Efficacy and Safety of Dronedarone in Patients Previously Treated With Other Antiarrhythmic Agents

A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation

Predictable and Less Predictable Unwanted Cardiac Drugs Effects: Individual Pre‐Disposition and Transient Precipitating Factors

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