Comparison of Amiodarone and Propafenone in Blanking Period after Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation: A Propensity Score‐Matched Study

Abstract

Background. Amiodarone and propafenone are commonly used to maintain sinus rhythm in patients with atrial fibrillation (AF). However, it is not known which one is better in reducing early recurrence (ER) during the blanking period (the first three months after catheter ablation). Objective. To compare the efficacy and safety of amiodarone and propafenone in reducing ER during the blanking period after radiofrequency catheter ablation (RFCA) in AF patients. Materials and Methods. A total of 694 patients who underwent their first RFCA between May 2014 and May 2018 were enrolled in this retrospective study. Subsequently, 202 patients were excluded according to the exclusion criteria. The remaining 492 patients were divided into two groups based on the choice of antiarrhythmic drugs (AADs) (amiodarone or propafenone) in the blanking period. The primary outcomes were incidence of ER and AAD-associated adverse effects during the blanking period after RFCA. Propensity score matching (PSM) analyses were used to compare the outcomes of the two groups while controlling for confounders. Results. Among the 492 patients who took AADs in the blanking period (187 amiodarone and 305 propafenone), PSM selected 135 unique pairs of patients with similar characteristics. Amiodarone was associated with a lower ER incidence rate (23.7% versus 48.9%, p<0.001) and a similar rate of AAD-associated adverse effects (2.1% versus 1.5%, p=0.652). Treatment with amiodarone in the blanking period was significantly associated with a lower ER incidence rate compared to treatment with propafenone (HR=0.416, 95% CI 0.272–0.637, p<0.001). Conclusions. Compared with propafenone, amiodarone was associated with a lower ER incidence rate, and they had similar rates of AAD-associated adverse effects. Treatment with amiodarone in the blanking period was shown to be more effective in reducing ER than propafenone.

Factors influencing early recurrence of atrial fibrillation among elderly patients following radiofrequency catheter ablation and the impact of different antiarrhythmic regimens

“…Currently, there is still limited information available on the optimal ADD treatment regimen for this special population following RFCA. Study have demonstrated class III antiarrhythmic drugs exhibiting a more pronounced effect ( 40 ). As a multi-ion channel blocker AAD, amiodarone is currently the most widely utilized AAD for the maintenance of sinus rhythm.…”

“…However, it is crucial to remain vigilant about the potential side effects of prolonged AAD usage especially in elderly patients. Amiodarone’s long half-life and tissue accumulation can potentially lead to multiple adverse drug reactions with prolonged use ( 40 ). Sotalol has a high risk of cardiotoxicity ( 44 ).…”

Association between the cumulative triglyceride-glucose index and the recurrence of atrial fibrillation after radiofrequency catheter ablation

“…Univariate Cox regression analysis for variables with P-value < 0.1 and other variables (including BMI, duration of AF, type of AAD, and ablation strategy) that have been proven to independently influence AF recurrence were finally ab- sorbed in multiple Cox regression analysis. [21][22][23][24][25] The multiple Cox regression analysis results showed that the cumulative TyG index values was an independent risk factor for AF recurrence after RFCA. Patients in the T2 and T3 groups had a higher recurrence risk within one year after ablation compared to the T1 group (T2: HR = 4.949, 95% CI: 1.778-13.778, P = 0.002; T3: HR = 8.716, 95% CI: 3.371-22.536, P < 0.001).…”

Cardiomyocyte-Targeting Peptide to Deliver Amiodarone

“…The superiority of rhythm over rate control in afib has been demonstrated in multiple randomized control trials [ 4 , 5 , 6 ]. Although amiodarone is the most efficacious anti-arrhythmic drug with demonstrated superiority over multiple other anti-arrhythmics like propafenone [ 7 , 8 ], sotalol [ 7 , 9 , 10 ], and dronedarone [ 11 , 12 ], it is grossly underutilized and remains a second-line therapy for maintenance of normal sinus rhythm in patients with afib. This is due to amiodarone being a highly lipophilic drug with a large volume of distribution [ 13 ], a long half-life, uptake by noncardiac tissues like lungs, liver, thyroid, skin and ocular tissue, leading to multiple off-target and potentially life-threatening toxicities, thus limiting its use to patients over 75 years of age or patients with limited life expectancies [ 14 ].…”