Evaluation of early direct current cardioversion for maintenance of sinus rhythm in rheumatic atrial fibrillation following successful balloon mitral valvotomy

Sharma, Gautam; Krishnan, Rakhee; Bohra, Vijay; Ramakrishnan, Sivasubramanian; Naik, Nitish; Seth, Sandeep; Juneja, Rajnish; Kalaivani, Mani; Bahl, Vinay K.

doi:10.1016/j.ihj.2015.11.013

Cited by 8 publications

(8 citation statements)

References 19 publications

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“…Benefits of restoring SR include symptomatic relief, improved exercise capacity and quality of life, possible reduction in embolic strokes and improved survival. 14 , 15 , 18 , 28 We also observed significant improvement in NYHA class and QOL scores in patients who were in SR as compared to those with persistent AF. Predictors of successful outcomes at 1 year were shorter duration of AF (<3.5 years) and smaller left atrial size (<51 mm).…”

Section: Discussionsupporting

confidence: 54%

“…Reported success rates vary from 38% using only pharmacological conversion with oral amiodarone 13 ; performing DCCV in patients pre-administered oral or IV amiodarone is known to further improve success rates to 55–96% (maintenance of SR at 1 year follow up). 14 , 15 , 27 , 28 …”

Section: Discussionmentioning

confidence: 99%

“…Data for long term rhythm control of rheumatic AF is scanty and amiodarone has been the usual rhythm control strategy in previous studies. 13 , 14 , 15 , 16 , 17 , 18 However, long-term drug related adverse effects can be an important concern, especially so as many of these patients are relatively young.…”

Section: Introductionmentioning

confidence: 99%

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A pilot study on the acute conversion and maintenance of sinus rhythm in rheumatic atrial fibrillation using oral flecainide

Ghosh

Kapoor

Khanna

et al. 2020

Indian Heart Journal

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Background Achievement of sinus rhythm (SR) is an important goal in rheumatic atrial fibrillation (AF). Studies in rheumatic AF have often used amiodarone for rhythm control. Flecainide has not been studied in these patients due to concerns of underlying structural heart disease. Methods Pharmacological cardioversion by oral single loading dose (SLD) of Flecainide (4 mg/kg, ≤300 mg) was tested in 50 patients with rheumatic AF (MVA 1.51 ± 0.19 mm 2 , age 46.2 ± 10.28 yrs, AF duration 3.10 ± 1.7 yrs, LA size: 44.42 ± 7.48 mm). Non-converters underwent DC cardioversion (DCC) at 24 h. All patients received oral flecainide and ββ/diltiazem at discharge. Results At 24 h, 38/50 (76%) achieved SR (2 with SLD; 36 after DCC). At 30 days (mean Flecainide dose 116.5 ± 10.5 mg) successful maintenance of SR was noted in 31/38 (89%). At 1 year, 30/38 (79%) of the initial converters and 60% of the overall population maintained SR. Those in SR had significantly better NYHA Class (1.1 ± 0.12 vs 1.3 ± 0.10, p = 0.03) and mean PCS8 score (50.11 ± 5.337 vs 46.84 ± 5.379, p = 0.02). AF duration (OR 0.594 CI 0.375–0.940, p = 0.02) and LA size (OR 0.840, CI 0.757–0.933, p = 0.001) were found to be the only significant predictors of successful outcomes. Patients with AF duration <3.5 years and LA size <51 mm had 85% and 75% chance of maintaining SR at 1 year, respectively. Conclusion Flecainide is safe and effective for achieving and maintaining SR in patients of rheumatic AF who are unlikely to have underlying coronary artery disease or ventricular dysfunction.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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A pilot study on the acute conversion and maintenance of sinus rhythm in rheumatic atrial fibrillation using oral flecainide

Ghosh

Kapoor

Khanna

et al. 2020

Indian Heart Journal

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“…One small randomised study evaluated the efficacy of early DCCV along with intravenous loading dose followed by low-dose short duration (100 mg/day during 6 weeks) amiodarone after successful PMC 36. At the end of a short follow-up period (range 6–9 months), 13/15 (87%) patients remained in SR, while 2 patients (13%) had reverted to AF, one at 2 weeks and one at 4 months.…”

Section: Medical Therapies Of Af and Its Complicationsmentioning

confidence: 99%

Management of atrial fibrillation in patients with rheumatic mitral stenosis

Iung

Leenhardt

Extramiana

2018

Heart

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Atrial fibrillation (AF) is frequent in patients with rheumatic mitral stenosis (MS). Pressure overload leads to marked structural and electrical remodelling of left atrium. The frequency of persistent AF increases with age and paroxysmal, asymptomatic, AF seems even more frequent. The occurrence of AF worsens the haemodynamic tolerance of MS and markedly increases the risk of thromboembolic events. AF has a negative impact on the natural history of MS and on its outcome after commissurotomy. The respective indications of rhythm and rate control should be adapted to patient characteristics, particularly the consequences of MS, and take into account the high risk of recurrence of AF. Oral anticoagulant therapy is mandatory when AF complicates MS, regardless of its severity and CHA2DS2-VASc score. Non-vitamin K antagonists oral anticoagulants are not recommended in moderate-to-severe MS due to the lack of data. Percutaneous mitral commissurotomy does not appear to prevent the occurrence of AF in MS but should be considered as the first-line therapy when AF is associated with severe symptomatic MS, followed by the discussion of cardioversion or ablation. AF ablation should be considered in patients with mitral disease requiring intervention, but the ideal timing and techniques are difficult to determine due to the lack of appropriate specific randomised trials in patients with MS.

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“…Vora et al [17] compared the rhythm control strategy with amiodarone versus rate control with diltiazem in patients with rheumatic AF and noted that patients treated with the rhythm control strategy presented a significant improvement in functional class, exercise capacity, and quality of life score compared with patients treated with the rate-control strategy. Sharma et al [18] randomized patients with rheumatic MS after balloon mitral valvotomy to the rhythm control strategy by electrical cardioversion followed by oral amiodarone versus placebo and found that patients in the rhythm control arm had a significantly better quality of life at the end of 6 months than those in the placebo arm.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Ibutilide for Acute Pharmacological Cardioversion of Rheumatic Atrial Fibrillation

Shenthar¹,

Banavalikar²,

Valappil³

et al. 2021

Cardiology

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Introduction: Ibutilide is indicated for acute cardioversion of nonvalvular atrial fibrillation (AF). However, its efficacy and safety in the pharmacological cardioversion of rheumatic AF are unknown. Methods: Patients with mild-to-moderate rheumatic mitral valve (MV) disease with symptomatic, paroxysmal, or persistent AF were included in the analysis. Intravenous ibutilide was administered at doses tailored to body weight (0.5–2.0 mg) for over 10 min. The primary end point was efficacy, assessed as the rate of conversion of AF to sinus rhythm. The secondary end point was safety, including arrhythmic events and death within 24 h of drug initiation. Results: From June 2016 to October 2018, 165 patients (94 with mitral stenosis, 23 with mitral regurgitation, 11 with mixed MV disease, and 37 with MV replacement) received ibutilide (mean dose 0.90 ± 0.54 mg). Ibutilide successfully converted AF to sinus rhythm in 127/165 (76.9%) patients, with a conversion time of 7.9 ± 4.1 min. The QTc increased from 419.9 ± 15.8 to 487.5 ± 34 ms after ibutilide administration (p < 0.001). The mean change in QTc after ibutilide administration (∆QTc) was 72.01 ± 36.03. There were no deaths, but 3 patients (1.8%) developed torsades de pointes (TdP) requiring defibrillation 55 ± 37 min after infusion. Conclusion: Ibutilide cardioverted 77% of rheumatic AF to sinus rhythm, indicating its potential as a clinically useful option for pharmacological cardioversion of rheumatic AF. TdP is a potentially serious adverse event that requires careful monitoring.

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Evaluation of early direct current cardioversion for maintenance of sinus rhythm in rheumatic atrial fibrillation following successful balloon mitral valvotomy

Abstract: In patients with rheumatic MS and AF, early DCCV and a short-duration oral Amiodarone, following successful PBMV, may be a reasonable strategy to attain long-term SR.

Cited by 8 publications

References 19 publications

A pilot study on the acute conversion and maintenance of sinus rhythm in rheumatic atrial fibrillation using oral flecainide

A pilot study on the acute conversion and maintenance of sinus rhythm in rheumatic atrial fibrillation using oral flecainide

Management of atrial fibrillation in patients with rheumatic mitral stenosis

Safety and Efficacy of Ibutilide for Acute Pharmacological Cardioversion of Rheumatic Atrial Fibrillation

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