Bucindolol hydrochloride in atrial fibrillation and concomitant heart failure

Abstract

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and it increases the risk of thromboembolic stroke and death. AF is common in patients with heart failure and reduced ejection fraction (HFrEF), affecting between 30 and 40% of patients with HFrEF. AF increases the risk of death and hospitalization in patients with HFrEF. Only two antiarrhythmic drugs (amiodarone and dofetilide) are guideline-recommended in patients with AF and heart failure (HF). Meta-analyses of studies of major trials in HF suggest that patients with AF/HFrEF do not benefit from conventional β-blockers. Bucindolol has shown promise in the treatment of patients with AF/HFrEF. We will explore how the shared pathophysiology of AF/HF is targeted by the unique pharmacology of bucindolol and review the existing data for bucindolol in AF/HF. We will explore findings that support a pharmacogenetically modulated effect of bucindolol in patients with polymorphisms in β1-adrenergic receptor and provide an overview of ongoing studies.

Should β-Blockers Be Used in Patients With Heart Failure and Atrial Fibrillation?

“…What interventions could be considered? Studies of bucindolol [42][43][44] and xamoterol, 45 β 1 partial agonists (ie, agents that act as β-blockers during periods of high sympathetic activity but as β-agonists when sympathetic activity is low) suggest that these agents reduce heart rate during activity and pauses when the patient is at rest or asleep. Whether these agents are beneficial in patients with heart failure and AF is uncertain, but they appear harmful or less effective than other agents for patients in sinus rhythm.…”