Randomized Crossover Study of the Long-Term Effects of Pilsicainide and Cibenzoline in Preventing Recurrence of Symptomatic Paroxysmal Atrial Fibrillation  Influence of the Duration of Arrhythmia Before Therapy

Kubo, Takashi; Satō, Yoshihiro; Tachibana, Hideaki; Nakamura, Motoyuki; Horiuchi, Daisuke; Okumura, Ken

doi:10.1253/circj.70.667

Cited by 23 publications

(16 citation statements)

References 25 publications

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“…The present study has demonstrated that the recurrencefree rate of the patients treated with amiodarone therapy at 12 months in Group A was similar to that in Group B, which suggests that the efficacy of oral amiodarone therapy in preventing recurrence of AF was not affected by the duration of arrhythmia. In contrast, we reported that class I antiarrhythmic drugs, such as disopyramide and cibenzoline, showed less efficacy in preventing recurrence of AF in patients whose duration of tachycardia was 48 h or more compared with similar patients in whom the duration was less than 48 h. [9][10][11] Thus, amiodarone may have favorable pharmacological actions for preventing the recurrence of AF for which class I antiarrhythmic drugs are ineffective.…”

Section: Discussionmentioning

confidence: 99%

“…The classifications were diurnal type (07.00 h to 17.00 h), nocturnal type (17.00 h to 07.00 h next morning), and mixed type (symptoms appeared at any time). 9 Patients who had severe bradycardia (sick sinus syndrome, atrioventricular block, and intraventricular conduction distubance), hepatic or renal dysfunction observed as abnormal test results, those receiving -blockers, those who had asymptomatic AF, and women who may have become pregnant were excluded from the study population.…”

Section: Methodsmentioning

confidence: 99%

“…7,8 However, the class I antiarrhythmic drugs have a therapeutic limitation. 9 We previously reported that the efficacy of cibenzoline and disopyramide in preventing recurrence of paroxysmal AF in patients in whom AF lasted for 48 h or more was inferior to that in those in whom AF lasted for less than 48 h before cardioversion. 10,11 Amiodarone, regarded as a class III antiarrhythmic drug, has been used to maintain SR only in Japanese patients with paroxysmal and obstructive hypertrophic cardiomyopathy, even though 2 large clinical trials have reported that the efficacy of amiodarone in preventing recurrence of paroxysmal and persistent AF is superior to that of the class I antiarrhythmic drugs and dl-sotalol.…”

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Efficacy of Amiodarone for Preventing the Recurrence of Symptomatic Paroxysmal and Persistent Atrial Fibrillation After Cardioversion

Kubo

Tachibana

Satō

et al. 2007

Circ J

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SubjectsThe study included 55 patients (37 men, 18 women, mean age 68±9 years) who have subjective symptoms of palpitation and who had electrocardiographically confirmed AF.Circ J 2007; 71: 46 -51 (Received June 7, 2006; revised manuscript received October 10, 2006; accepted October 17, 2006) Efficacy of Amiodarone for Preventing the Recurrence of Symptomatic Paroxysmal and Persistent Atrial Fibrillation After CardioversionTakashi Komatsu, MD; Hideaki Tachibana, MD; Yoshihiro Sato; Mahito Ozawa; Motoyuki Nakamura, MD; Ken Okumura, MD* Background It has been previously reported that the efficacy of class I antiarrhythmics in preventing the recurrence of symptomatic paroxysmal and persistent atrial fibrillation (AF) is limited when AF lasts for 48 h or more. However, it is unclear whether the efficacy of amiodarone, a class III drug, is superior to class I antiarrhythmics in patients with long-lasting AF. Method and ResultsThe relationship between the duration of tachycardia and the efficacy of amiodarone in preventing recurrence of tachycardia was examined in 55 patients (37 men, 18 women, mean age 68±9 years) to whom amiodarone was administered after electrical or pharmacological cardioversion for paroxysmal and persistent AF. In 26 patients, paroxysmal and persistent AF ceased within 48 h after onset (Group A), and in the other 29 patients, it ceased after 48 h (Group B). Patient characteristics and actuarial recurrence-free rates were compared between the 2 groups. The mean follow-up period was 30±11 months. No statistically significant difference between the groups was found in patient characteristics. Actuarial recurrence-free rates in Group A and B at 1, 3, 6, 9, and 12 months were 100%, 81%, 69%, 62%, and 54%, and 93%, 79%, 66%, 52%, and 48%, respectively (p= NS at 12 months). The period of maintenance of sinus rhythm was 14.7±3.2 months in group A and 13.3±3.3 months in group B (mean ± SE, p= NS). Conclusion In the case of amiodarone, efficacy for maintaining sinus rhythm after cardioversion of AF was not biased by the duration of arrhythmia. This observation suggests amiodarone is effective in maintaining normal sinus rhythm after cardioversion, even in patients with long-lasting AF and electrical atrial remodeling.(Circ J 2007; 71: 46 -51)

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Efficacy of Amiodarone for Preventing the Recurrence of Symptomatic Paroxysmal and Persistent Atrial Fibrillation After Cardioversion

Kubo

Tachibana

Satō

et al. 2007

Circ J

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“…2 Because atrial remodeling, including changes in the electrophysiological properties or atrial structure, may exaggerate the occurrence of AF, controlling this process should be one of the important issues in the management of clinical AF. There have been several reports focusing on preventing the progression of atrial electrical remodeling by various drugs, such as antiarrhythmic agents, 3,4 or angiotensin-receptor blockers. 5,6 Some have been reported as effective for the partial suppression of electrical remodeling, but a more important issue is the recovery of the electrophysiological properties after the promotion of electrical remodeling because most clinical therapies would be instituted after the appearance of AF.…”

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Inhomogenic Effect of Bepridil on Atrial Electrical Remodeling in a Canine Rapid Atrial Stimulation Model

Fukaya

Niwano

Satoh

et al. 2008

Circ J

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BackgroundThe antiarrhythmic or reverse remodeling effects of bepridil, a multi-ion channel blocker, have been recently reported, but inhomogeneity of the electrical remodeling and effects of bepridil have been observed in previous reports. In this study, the effect of long-term administration of bepridil on atrial electrical remodeling was evaluated in a comparison of the right and left atrium (RA and LA) in a canine rapid atrial stimulation model. Methods and ResultsIn 10 beagle dogs, rapid atrial pacing (400 beats/min) was delivered for 6 weeks and the atrial effective refractory period (AERP), conduction velocity (CV) and inducibility of atrial fibrillation (AF) were evaluated every week. In 5 of the pacing dogs, bepridil (10 mg·kg -1 ·day -1 ) was administered orally, starting 2 weeks after the initiation of the rapid pacing. At the end of the protocol, the hemodynamic parameters and extent of tissue fibrosis were evaluated and the mRNA of SCN5A, Kv4.3, the L-type Ca 2+ channel (LCC) and connexin (Cx) 40, 43, and 45 in both atria were examined by quantitative real-time reverse transcriptase-polymerase chain reaction. In the pacing control group, AERP shortening, decreased CV, increased AF inducibility and downregulation of the expression of SCN5A and LCC were observed. In the bepridil group, the AERP exhibited a relatively quick recovery after bepridil was started in the first week and continued to recover gradually until the end of the protocol, but that recovery was smaller in the LA than in the RA. The CV was not affected by bepridil administration. AF inducibility was well suppressed in the RA in the bepridil group, but the induction of short-duration AF could not be suppressed in the LA. The mRNA downregulation of the LCC and SCN5A was negated by bepridil administration in the RA; but not in the LA; however, the data showed similar tendencies. There were no significant differences in the hemodynamic parameters or tissue fibrosis and the mRNA expression of Kv4.3, Cx40, 43, and 45 between the pacing control and bepridil groups. Conclusion Bepridil exhibited an anti-electrical remodeling effect in this study as previously reported, but the effect was inhomogeneous between the RA and LA, with the LA appearing to be more resistant to the effect of bepridil. (Circ J 2008; 72: 318 -326)

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“…19) If sinus rhythm is not restored soon after the onset of AF, the efficacy of subsequent antiarrhythmic therapy will be reduced. 20,21) It is possible that treatment was less effective in the asymptomatic AF group than in the symptomatic AF group because recurrence of AF may not have been detected during follow-up as it did not cause subjective symptoms in the asymptomatic group. Furthermore, since the time of initial onset was unclear in patients with asymptomatic AF, it is possible that some patients were already resistant to antiarrhythmic drug therapy at their first hospital visit because of a long interval since onset of AF.…”

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confidence: 99%

Efficacy of Antiarrhythmic Drug Therapy in Preventing Recurrence of Atrial Fibrillation and Long-Term Cardiovascular Prognosis in Patients With Asymptomatic Paroxysmal Atrial Fibrillation

et al. 2010

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SummaryWe evaluated the efficacy of antiarrhythmic drug therapy (AAD) and long-term cardiovascular prognosis in patients with asymptomatic paroxysmal atrial fibrillation (AF). This retrospective study included 334 patients (229 men and 105 women, mean age, 69 ± 11 years, mean follow-up, 60 ± 11 months) who were divided into two groups; patients with symptomatic AF (group I) and those with asymptomatic AF (group II) on the basis of subjective symptoms.(1) Actuarial rates of patients without AF recurrence, those with AF recurrence and with electrical/pharmacological cardioversion to restore sinus rhythm, and those with conversion to permanent AF despite AAD were 40%, 41%, and 19%, respectively, in group I, and 22%, 24%, and 54%, respectively, in group II at the end of the followup period. At 60 months, the percentage of patients with conversion to the permanent form of AF was significantly greater in group II than in group I (P < 0.05, group I versus group II). (2) Survival rates free from symptomatic thromboembolism at 36, 60, and 120 months were 96%, 93%, and 88%, in group I, and 82%, 76%, and 71%, respectively, in group II (P < 0.05, group I versus group II). In patients not undergoing anticoagulant therapy, the annual rate of symptomatic thromboembolism was significantly greater in group II (5.3%) than in group I (2.3%) (P < 0.05), while in patients undergoing anticoagulant therapy there was no significant difference in the annual rate of symptomatic thromboembolism between group I (0.9%) and group II (1.8%).The clinical course of asymptomatic paroxysmal AF is refractory to AAD when compared to symptomatic AF, meaning that anticoagulant therapy is required to prevent symptomatic thromboembolism in this group. (Int Heart J 2010; 51: 98-104) Key words: Atrial fibrillation, Prophylactic efficacy, Prognosis, Antiarrhythmic therapy, Ischemic stroke A ccording to a large-scale epidemiological survey performed in Western countries, atrial fibrillation (AF), which is often encountered in daily practice, is an independent risk factor for cardiovascular death, 1) and the risk of such death is 2-3 times higher in patients with AF than in those with sinus rhythm.2) Some patients do not develop any symptoms after the onset of AF, while others may suffer severe restriction of their daily activities even when the episodes of AF are as short as several seconds to a few minutes. Therefore, there are wide individual differences in the symptoms of AF. It has been reported the incidence of asymptomatic AF is 10-40%.3-6) However, the clinical characteristics and prognosis of AF patients have not been elucidated completely in Japan.In this study, we compared asymptomatic AF and symptomatic AF with respect to clinical characteristics, the long-term prophylactic efficacy of antiarrhythmic drug therapy, and cardiovascular survival. MethodsSubjects: The subjects in this study were 334 patients (229 men and 105 women, mean age, 69 ± 11 years) with paroxysmal AF who were monitored at hospital visits every 2-4 weeks and could be observed ...

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Randomized Crossover Study of the Long-Term Effects of Pilsicainide and Cibenzoline in Preventing Recurrence of Symptomatic Paroxysmal Atrial Fibrillation Influence of the Duration of Arrhythmia Before Therapy

Cited by 23 publications

References 25 publications

Efficacy of Amiodarone for Preventing the Recurrence of Symptomatic Paroxysmal and Persistent Atrial Fibrillation After Cardioversion

Efficacy of Amiodarone for Preventing the Recurrence of Symptomatic Paroxysmal and Persistent Atrial Fibrillation After Cardioversion

Inhomogenic Effect of Bepridil on Atrial Electrical Remodeling in a Canine Rapid Atrial Stimulation Model

Efficacy of Antiarrhythmic Drug Therapy in Preventing Recurrence of Atrial Fibrillation and Long-Term Cardiovascular Prognosis in Patients With Asymptomatic Paroxysmal Atrial Fibrillation

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