Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: a systematic review and meta-analysis

Um, Kevin J.; McIntyre, William F.; Healey, Jeff S.; Mendoza, Pablo; Koziarz, Alex; Amit, Guy; Chu, Victor A.; Whitlock, Richard; Belley‐Côté, Emilie P.

doi:10.1093/europace/euy310

Cited by 35 publications

(35 citation statements)

References 40 publications

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“…Results from clinical trials demonstrated that pretreated with antiarrhythmic drugs (AADs) before ECV could improve restoration and maintenance of sinus rhythm in persistent AF ( 40 , 41 ), in agreement with our findings. In a recent meta-analysis of 8 studies, treatment with amiodarone was found to be associated with higher rates of restoration (relative risk [RR], 1.22; 95% CI, 1.07–1.39) and long-term maintenance (RR, 4.39; 95% CI, 2.99–6.45) of sinus rhythm ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

“…Of these, ECV is recommended as first-line medical therapy for symptomatic patients with persistent AF ( 3 ). However, some studies reported ECV failed to restore sinus rhythm in 12–26% of persistent AF patients ( 4 , 5 ), and the rate of AF recurrence is up to 57–63% within 30 days after ECV ( 6 ). Thus, there is a unmet need to identify better regimes on restoration and maintenance of sinus rhythm in patients with persistent AF who underwent ECV.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Sacubitril-Valsartan on Restoration and Maintenance of Sinus Rhythm in Patients With Persistent Atrial Fibrillation

Chen

Chen²,

Qin³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundExisting studies have shown that sacubitril-valsartan ameliorated atrial remodeling in atrial fibrillation (AF) and favored maintenance of sinus rhythm in patients with AF and heart failure. However, the effect of sacubitril-valsartan in patients with persistent AF is yet unknown. We aimed to evaluate the effect of sacubitril-valsartan on restoration and maintenance of sinus rhythm in patients with persistent AF who underwent electrical cardioversion (ECV).MethodConsecutive patients with persistent AF who underwent ECV between 1 January 2016 and 30 September 2020 were investigated in this retrospective cohort study. All eligible patients were categorized into sacubitril-valsartan users and sacubitril-valsartan non-users based on whether they received treatment with sacubitril-valsartan or not. The endpoint was ineffictive ECV, defined as the composite of failure to terminate AF or any recurrence of AF during 30 days follow-up.ResultsA total of 76 patients were enrolled in this study, including 28 sacubitril-valsartan users and 48 non-users. Within a follow-up of 30 days after ECV, the endpoint had occurred in 7 (25%) of 28 sacubitril-valsartan users and 25 (52%) of 48 non-users. Significantly lower rate of ineffictive ECV in sacubitril-valsartan users compared with non-users was shown in Kaplan-Meier survival curves (P = 0.02; Log-rank test). Multivariate Cox regression analysis indicated that sacubitril-valsartan use (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.14–0.91), amiodarone use (HR, 0.32; 95% CI, 0.13–0.78), left atrial diameter ≤ 39 mm (HR, 0.21; 95% CI, 0.06–0.71) were independently associated with a decreased rate of ineffective electrical cardioversion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Sacubitril-Valsartan on Restoration and Maintenance of Sinus Rhythm in Patients With Persistent Atrial Fibrillation

Chen

Chen²,

Qin³

et al. 2022

Front. Cardiovasc. Med.

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“… 12 , 13 Rate control strategy is indicated in refractory cases and in patients who do not receive chronic therapy with an oral anticoagulant and with AF onset > 48 h. B-blockers, digoxin or amiodarone are the pharmacologic agents recommended for acute rate control in these cases to decrease ventricular rate and improve ventricular filling and stroke volume (Class of recommendation IIa). 3 , 25 ,26 B-blockers can be used with caution in acute phases because of their rapid onset of action and of their effect on sympathetic tone. 27 Digoxin should be considered as second-line therapy in patients with increased ventricular rates despite b-blockers use or in case b-blockers are contraindicated or non-tolerated 12 , 28 .…”

Section: Atrial Tachyarrhythmias and Cardiogenic Shockmentioning

confidence: 99%

The role of landiolol in the management of atrial tachyarrhythmias in patients with acute heart failure and cardiogenic shock: case reports and review of literature

Bezati

Velliou

Polyzogopoulou

et al. 2022

European Heart Journal Supplements

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Atrial tachyarrhythmias and worsening heart failure frequently coexist and potentially progress to a life threatening condition. Therapeutic approach requires simultaneous management of rapid ventricular response and heart failure symptom relief in order to improve haemodynamic stability and cardiac function. Landiolol is an ultra-short-acting b-adrenergic receptor blocker with high b1 selectivity incorporated in 2020 European Society of Cardiology guidelines for the management of atrial fibrillation. We provide a report of two cases with atrial fibrillation treated with landiolol in the acute setting of pulmonary oedema and cardiogenic shock, respectively. Additionally, we searched the international database PUBMED (MEDLINE, PubMed Central) to retrieve scientific evidence regarding its implementation in the treatment of atrial tachyarrhythmias in patients with cardiac dysfunction. Recent studies support the use of landiolol in patients with acute heart failure and atrial tachyarrhythmias. Compared to digoxin, landiolol proved to be more effective in controlling heart rate, with minimal adverse effects. Moreover, landiolol may be helpful in the conversion of atrial tachyarrhythmia to sinus rhythm. A more potent effect has been reported in patients with heart failure with preserved or mildly reduced ejection fraction, small left ventricular volume and high blood pressure. Likewise, administration of low doses of landiolol in patients with cardiogenic shock and atrial tachyarrhythmias reduced heart rate and pulmonary capillary wedge pressure and improved cardiac contractility without reducing blood pressure. Landiolol seems to be an attractive alternative in the acute management of patients with atrial tachyarrhythmias and cardiac dysfunction, though further clinical trials are needed to establish its role.

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“…In the case of hemodynamic instability in patients with AF, urgent electrical cardioversion is necessary. Administration of amiodarone prior to electroconversion has been shown to improve the likelihood of sinus rhythm conversion in patients with AF [ 63 ]. In addition, a study by Schmidt et al showed that the application of a maximum energy of 360 J is more effective in cardioversion of AF to sinus rhythm compared to a successively increased energy dose (125 J–150 J–360 J) [ 64 ].…”

Section: Treatment Of Patients With Af Within Amimentioning

confidence: 99%

Use of Anticoagulant Therapy in Patients with Acute Myocardial Infarction and Atrial Fibrillation

et al. 2022

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The incidence of atrial fibrillation (AF) in acute coronary syndrome (ACS) ranges from 2.3–23%. This difference in the incidence of AF is explained by the different ages of the patients in different studies and the different times of application of both reperfusion and drug therapies in acute myocardial infarction (AMI). About 6–8% of patients who underwent percutaneous intervention within AMI have an indication for oral anticoagulant therapy with vitamin K antagonists or new oral anticoagulants (NOAC).The use of oral anticoagulant therapy should be consistent with individual risk of bleeding as well as ischemic risk. Both HAS-BLED and CHA2DS2VASc scores are most commonly used for risk assessment. Except in patients with mechanical valves and antiphospholipid syndrome, NOACs have an advantage over vitamin K antagonists (VKAs). One of the advantages of NOACs is the use of fixed doses, where there is no need for successive INR controls, which increases the patient’s compliance in taking these drugs. The use of triple therapy in ACS is indicated in the case of patients with AF, mechanical valves as well as venous thromboembolism. The results of the studies showed that when choosing a P2Y12 receptor blocker, less potent P2Y12 blockers such as Clopidogrel should be chosen, due to the lower risk of bleeding. It has been proven that the presence of AF within AMI is associated with a higher degree of reinfarction, more frequent stroke, high incidence of heart failure, and there is a correlation with an increased risk of sudden cardiac death. With the appearance of AF in ACS, its rapid conversion into sinus rhythm is necessary, and in the last resort, good control of heart rate in order to avoid the occurrence of adverse clinical events.

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Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: a systematic review and meta-analysis

Cited by 35 publications

References 40 publications

Effect of Sacubitril-Valsartan on Restoration and Maintenance of Sinus Rhythm in Patients With Persistent Atrial Fibrillation

Effect of Sacubitril-Valsartan on Restoration and Maintenance of Sinus Rhythm in Patients With Persistent Atrial Fibrillation

The role of landiolol in the management of atrial tachyarrhythmias in patients with acute heart failure and cardiogenic shock: case reports and review of literature

Use of Anticoagulant Therapy in Patients with Acute Myocardial Infarction and Atrial Fibrillation

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