Efficacy and safety of antazoline for cardioversion of atrial fibrillation: propensity score matching analysis of multicenter registry (CANT II Study)

Wybraniec, Maciej T.; Maciąg, Aleksander; Miśkowiec, Dawid; Ceynowa-Sielawko, Beata; Balsam, Paweł; Wójcik, Maciej; Wróbel, Wojciech; Farkowski, Michał M.; Cwiek-Rebowska, E; Szołkiewicz, Marek; Ozierański, Krzysztof; Błaszczyk, Robert; Bula, Karolina; Dembowski, T; Peller, Michał; Krzowski, Bartosz; Wańha, Wojciech; Koziński, Marek; Kasprzak, Jarosław D.; Szwed, Hanna; Mizia‐Stec, Katarzyna

doi:10.20452/pamw.16234

Cited by 12 publications

(26 citation statements)

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“…Recently, a Polish study described antazoline as superior to propafenone and amiodarone in sinus rhythm conversion, with the adverse effect rate comparable and in line with our results. The authors recommended conducting randomized controlled trials to validate these findings [ 36 ]. While PSA was frequently associated with transient respiratory depression requiring temporary ventilation, this is a widely recognized adverse effect of this procedure and is not a limitation to its performance in the ED setting [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Various Atrial Fibrillation Treatment Strategies on Length of Stay in the Emergency Department and Early Complications—3 Years of a Single-Center Experience

Kłosiewicz,

Cholerzyńska,

Zasada

et al. 2023

JCM

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Atrial fibrillation (AF) is the most common arrhythmia presenting in emergency departments (EDs), vastly increasing mainly due to society’s lifestyles leading to numerous comorbidities. Its management depends on many factors and is still not unified. Aims: The aim of this study was to compare different AF management strategies in the ED and to evaluate their influence on the length of stay (LOS) in the ED and their safety. We analyzed medical records over 3 years of data collection, including age, primary AF diagnosis, an attempt to restore sinus rhythm, complications, and length of stay. Patients were divided into three groups according to the treatment method received: only pharmacological cardioversion (MED), only electrical cardioversion (EC), and patients who received medications followed by electrical cardioversion (COMB). We included 599 individuals in the analysis with a median age of 71. The restoration of sinus rhythm and LOS were as follows: MED: 64.95%, 173 min; COMB: 87.91%, 295 min; SH: 92.40%, 180 min. The difference between the MED and EC strategies, as well as MED and COMB, was statistically significant (p < 0.001 in both). The total number of complications was 16, with a rate of 32.67%. The majority of them followed a drug administration, and the most common complication was bradycardia. Electrical cardioversion is a safe and effective treatment strategy in stable patients with AF in the ED. It is associated with a shortened LOS. Medication administration preceded the majority of complications.

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Section: Discussionmentioning

confidence: 99%

Impact of Various Atrial Fibrillation Treatment Strategies on Length of Stay in the Emergency Department and Early Complications—3 Years of a Single-Center Experience

Kłosiewicz,

Cholerzyńska,

Zasada

et al. 2023

JCM

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“…This research represents a sub-analysis of the real-life cardioversion with intravenous ANTazoline in the Atrial Fibrillation II registry (CANT II study), which comprised 1365 consecutive patients with short-duration AF qualified for urgent pharmacological cardioversion. The rationale, design, and main results of the study were thoroughly described earlier [13]. In brief, this was a retrospective multicenter registry conducted in 6 centers throughout Poland using the Scientific Platform of the "Club 30" of the Polish Cardiac Society between June 2019 and February 2020.…”

Section: Methodsmentioning

confidence: 99%

“…In brief, this was a retrospective multicenter registry conducted in 6 centers throughout Poland using the Scientific Platform of the "Club 30" of the Polish Cardiac Society between June 2019 and February 2020. The study included eligible patients with paroxysmal or persistent atrial fibrillation, who did not meet exclusion criteria [13]. Patients were qualified for pharmacological cardioversion in the emergency department according to local practice.…”

Section: Methodsmentioning

confidence: 99%

Antiarrhythmic drugs for pharmacological cardioversion of atrial fibrillation and sex differences: Insights from the CANT II Study

Wybraniec,

Maciąg,

Miśkowiec

et al. 2023

Kardiol Pol

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Background: Data on sex differences in terms of action of antiarrhythmic agents (AADs) are limited. This study aimed to evaluate the clinical profile of patients with atrial fibrillation (AF), and efficacy and safety of AADs used for pharmacological cardioversion (PCV) of AF.Methods: This research was a sub-analysis of the retrospective multicenter Cardioversion with ANTazoline II (CANT) registry, which comprised 1365 patients with short-duration AF referred for urgent PCV with the use of AAD. Patients were categorized according to and compared in terms of clinical parameters and PCV outcomes. The primary endpoint was return of sinus rhythm within 12 hours after drug infusion, and the composite safety endpoint involved bradycardia <45 bpm, hypotension, syncope, or death. Results:The sex distribution of patients qualified for PCV was even (men, n = 725; 53.1%). Females were older and more symptomatic and had higher CHA 2 DS 2 -VASc scores, higher prevalence of tachyarrhythmia, and higher use of chronic anticoagulation. The overall efficacy (71.4% vs. 70.1%; P = 0.59) and safety (5.2% vs. 4.6%; P = 0.60) of PCV was comparable in men and women. Amiodarone (68.3% vs. 65.9%; P = 0.66) and antazoline (77.1% vs. 80.0%; P = 0.19) had similar efficacy in men and women, but propafenone had a lower rate of rhythm conversion in men (64.7% vs. 79.3%; P = 0.046). None of the assessed AADs differed in terms of safety profile in both sexes. Conclusion:Female patients with AF have different clinical profiles but similar efficacy and safety of AADs as compared to male participants. Propafenone has significantly lower efficacy in men, which requires further investigation.

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“…The CANT (Cardioversion with Intravenous Antazoline Mesylate) II study, a multicenter, retrospective real-world registry, demonstrated that antazoline is noninferior to other available antiarrhythmic drugs, including amiodarone and propafenone, in terms of successful rhythm conversion among 1365 patients admitted to the ED with new onset AF, 9.4% of whom had an LVEF < 50%. Concerning the safety profile, the rate of serious adverse events, such as bradycardia below 45 bpm, hypotension, syncope or death, was higher in the antazoline group compared to the amiodarone group (5.2% versus 2.1%), but it was comparable between the antazoline group and the propafenone group (5.2% versus 7.3%) [69]. However, antazoline is not formally listed in the latest published ESC guidelines for the management of AF [1].…”

Section: Rhythm Controlmentioning

confidence: 97%

The Optimal Management of Patients with Atrial Fibrillation and Acute Heart Failure in the Emergency Department

Velliou,

Sanidas,

Diakantonis

et al. 2023

Medicina

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Atrial fibrillation (AF) and acute heart failure (AHF) are two closely interrelated conditions that frequently coexist in a manifold manner, with AF serving either as the causative factor or as the consequence or even as an innocent bystander. The interplay between these two clinical conditions is complex, given that they share common pathophysiological pathways and they can reciprocally exacerbate each other, thus triggering a vicious cycle that worsens the prognosis and increases the thromboembolic risk. The optimal management of AF in the context of AHF in the emergency department remains a challenge depending on the time onset, as well as the nature and the severity of the associated symptoms. Acute rate control, along with early rhythm control, when indicated, and anticoagulation represent the main pillars of the therapeutic intervention. The purpose of this review is to elucidate the pathophysiological link between AF and AHF and accordingly present a stepwise algorithmic approach for the management of AF in AHF patients in the emergency setting.

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Efficacy and safety of antazoline for cardioversion of atrial fibrillation: propensity score matching analysis of multicenter registry (CANT II Study)

Cited by 12 publications

References 0 publications

Impact of Various Atrial Fibrillation Treatment Strategies on Length of Stay in the Emergency Department and Early Complications—3 Years of a Single-Center Experience

Impact of Various Atrial Fibrillation Treatment Strategies on Length of Stay in the Emergency Department and Early Complications—3 Years of a Single-Center Experience

Antiarrhythmic drugs for pharmacological cardioversion of atrial fibrillation and sex differences: Insights from the CANT II Study

The Optimal Management of Patients with Atrial Fibrillation and Acute Heart Failure in the Emergency Department

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