Rapid pharmacological cardioversion of recent-onset atrial fibrillation using antazoline in elderly patients

Farkowski, Michał M.; Maciąg, Aleksander; Zurawska, Malgorzata; Kołakowski, Karol; Gardziejczyk, Piotr; Kowalik, Ilona; Szwed, Hanna; Pytkowski, Mariusz

doi:10.20452/pamw.16120

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…In the earlier CANT I study [23] and the current high-volume CANT II study [13], antazoline has been shown to have comparable efficacy to propafenone and superior efficacy to amiodarone in terms of the rate of rhythm conversion. Also, Farkowski et al found that antazoline is characterized by even better efficacy than propafenone [24], and its efficacy extended to the elderly population [25]. What is more, none of the above-mentioned results indicated serious adverse events related to the use of antazoline in comparison to other AADs.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…However, during the last decade, new data have emerged showing that antazoline also has an antiarrhythmic activity with quinidine-like properties and is effective in the termination of paroxysmal atrial fibrillation (AF) [ 1 , 2 , 3 , 4 ]. In addition to the fact that antazoline quickly and effectively terminates AF, it is also safe in the elderly and in the patients with stable coronary artery disease [ 5 , 6 ]. These effects of antazoline’s use in cardiology and emergency medicine have been recently described in a comprehensive review published by [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Development and Performance Verification of the PBPK Model for Antazoline and Its Metabolite and Its Utilization for Pharmacological Hypotheses Formulating

et al. 2022

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Antazoline is an antihistaminic drug that is effective in the termination of paroxysmal atrial fibrillation. Despite its long presence in the market, antazoline’s ADME parameters and pharmacokinetic effects in humans are poorly characterized. The objective of this study was to fill this gap by generation of in vitro and in vivo data and the development of a physiologically based pharmacokinetic model describing antazoline and its main metabolite disposition. A set of ADME parameters for the antazoline and its hydroxy metabolite is provided based on literature data, QSAR predictions, in vitro binding and metabolic stability assays. These can be used to feed PBPK models. In our current work, the developed PBPK model simulating simultaneously the pharmacokinetic profile of antazoline and its metabolite was successfully verified against the available clinical data and the presented capability to account for the clinically observed variability. When used to feed the PD model (e.g., simulating ECG), concentration-time profiles predicted by the model enable the assessment of antazoline’s effect in various clinical scenarios with the possibility to account for population differences or CP mediated drug-drug interactions.

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“…The gold standard for the exclusion of LAAT is transesophageal echocardiography (TOE) [9,10]. However, there are no unequivocal data on whether patients awaiting ablation or electric cardioversion should routinely undergo TOE, which is an invasive procedure that should be performed by trained and experienced personnel [11][12][13][14]. Risk stratification according to sex is common in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Differences in the predictors of left atrial appendage thrombus between men and women treated with dabigatran or rivaroxaban

Ciba-Stemplewska¹,

Gorczyca²,

Kapłon‐Cieślicka³

et al. 2022

Polish Archives of Internal Medicine

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The gold standard for the exclusion of left atrial appendage thrombus (LAAT) is transesophageal echocardiography (TOE). There are no unequivocal data on whether patients awaiting ablation or electric cardioversion should routinely undergo TOE, which is an invasive procedure performed by trained and experienced personnel. Some patients with atrial fibrillation (AF) develop LAAT despite receiving anticoagulant treatment. The CHADS2 and CHA2DS2-VASc scores are used to assess thromboembolic risk in patients with nonvalvular AF. The CHA2DS2-VASc-RAF score has been developed to improve thromboembolic risk stratification. In this study, we identified sex-related predictors of LAAT in patients treated with dabigatran or rivaroxaban. All the assessed scores had a similar predictive value in men, while the CHA2DS2-VASc-RAF score had the highest predictive value in women.

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Rapid pharmacological cardioversion of recent-onset atrial fibrillation using antazoline in elderly patients

Cited by 3 publications

References 10 publications

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

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

Development and Performance Verification of the PBPK Model for Antazoline and Its Metabolite and Its Utilization for Pharmacological Hypotheses Formulating

Differences in the predictors of left atrial appendage thrombus between men and women treated with dabigatran or rivaroxaban

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