Old and new antiarrhythmic drugs for converting and maintaining sinus rhythm in atrial fibrillation: comparative efficacy and results of trials

Naccarelli, Gerald V.; Wolbrette, Deborah L.; Khan, M. Rashid; Bhatta, Luna; Hynes, John K.; Samii, Soraya; Luck, Jerry C.

doi:10.1016/s0002-9149(02)03375-1

Cited by 161 publications

(111 citation statements)

References 94 publications

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“…They received immediately intravenous bolus (in a few minutes) of flecainide (2 mg/ kg), propafenone (2 mg/kg), or amiodarone (5 mg/kg) [5,11,[16][17][18][19]. The chart of time to treatment is shown in Fig.…”

Section: Management Of Patients and Study Protocolmentioning

confidence: 99%

Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations

Conti

Canuti

Mariannini

et al. 2012

The American Journal of Emergency Medicine

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Background: Novel facilities such as an intensive observation unit and an outpatient clinic could result in improving management of patients presenting with atrial fibrillation (AF). Methods: This observational study enrolled 3475 patients. Group 1 (1120 patients; years [2004][2005] was managed with standard approach; group 2 (992 patients; years [2006][2007] was managed with additional intensive observation; group 3 (1363 patients; years 2008-2009) was managed with additional intensive observation and outpatient clinic. Primary end point was admission to hospital. Secondary end points included modalities of rhythm conversion and administration of class IC vs class III antiarrhythmic drugs in patients with AF lasting less than 48 hours. Results: Lack of rhythm control, comorbidities, diabetes, and age were independent predictors of hospitalization. Admissions significantly decreased from group 1 (50%) to 2 (38%) and to 3 (24%) (P b .001). Interestingly, more than a quarter of patients in group 3 were referred to the outpatient clinic for short-term follow-up, eventually avoiding admission. Patients with AF lasting less than 48 hours (n = 2189) and without structural heart disease (n = 1685) achieved sinus rhythm in 89% of cases and were discharged. In these patients, early administration of antiarrhythmic drugs of class IC and III gained sinus rhythm in 80% and 20%, respectively (P b .001). Spontaneous conversion occurred in 26%; electrical, 17%; and pharmacological, 57%. Conclusions: In patients with AF, beyond the standard approach, the novel organization with an additional intensive observation unit for early pharmacological interventions and an outpatient clinic for elective treatment and short-term follow-up significantly reduced admission irrespective of independent predictors of hospitalizations. Patients without structural heart disease treated with antiarrhythmic drugs achieved sinus rhythm in 89% of cases, mostly with class IC drugs.

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Section: Management Of Patients and Study Protocolmentioning

confidence: 99%

Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations

Conti

Canuti

Mariannini

et al. 2012

The American Journal of Emergency Medicine

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“…It is well known that existing medication with class I or III antiarrhythmic agents, such as dofetilide and sotalol, 28,29 could bring about negative feedback impact on the ventricular repolarization, which is generally considered as a critical risk factor for fatal arrhythmias. These life-threatening adverse effects, attributable to the unselective blockade of the potassium currents in both atrial and ventricular cardiomyocytes, 30 hindered the appropriate application of these antiarrhythmic drugs to patients in clinical practice.…”

Section: Kcna5 Mutations and Atrial Fibrillation Y Yang Et Almentioning

confidence: 99%

Novel KCNA5 loss-of-function mutations responsible for atrial fibrillation

et al. 2009

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Accumulating evidence reveals that genetic variants play pivotal roles in familial atrial fibrillation (AF). However, the molecular defects in most patients with AF remain to be identified. Here, we report on three novel KCNA5 mutations that were identified in 4 of 120 unrelated AF families. Among them, T527M was found in two AF families, and A576V and E610K in two other AF families, respectively. The mutations T527M and A576V were also detected in 2 and 1 of 256 patients with idiopathic AF, respectively. The same mutations were not observed in 200 secondary AF patients and 500 controls. Functional analyses revealed consistent loss-of-function effects of mutant KCNA5 proteins on the ultrarapidly activating delayed rectifier potassium currents. These findings expand the spectrum of mutations in KCNA5 linked to AF and provide new insight into the molecular mechanism involved in AF.

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“…Kaplan-Meier survival analysis revealed that 74% of patients with hsCRP at 48 h o2.27 mg l À1 maintained sinus rhythm at the end of 1-year follow-up, whereas the corresponding percentage for patients with hsCRP at 48 h X2.27 mg l À1 value was only 33.3%, that is 2.2 times lower ( Figure 5). The PLR and NLR for this cut-off value were 2.14 and 0.42, respectively, and by considering that pre-test recurrence probability for 1 year after cardioversion is up to 75%, 20 the posttest probability for PAF relapse in 1 year after cardioversion for patients with hsCRP at 48 h X2.27 mg l À1 is about 88%.…”

Section: Af Recurrencementioning

confidence: 97%

Hypertension and paroxysmal atrial fibrillation: a novel predictive role of high sensitivity C-reactive protein in cardioversion and long-term recurrence

et al. 2010

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Old and new antiarrhythmic drugs for converting and maintaining sinus rhythm in atrial fibrillation: comparative efficacy and results of trials

Cited by 161 publications

References 94 publications

Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations

Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations

Novel KCNA5 loss-of-function mutations responsible for atrial fibrillation

Hypertension and paroxysmal atrial fibrillation: a novel predictive role of high sensitivity C-reactive protein in cardioversion and long-term recurrence

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