Revisiting the Role of Antiarrhythmic Drugs in Prevention of Atrial Fibrillation Recurrence: A Single Center Retrospective Review

Mascarenhas, Daniel; Sharma, Munish

doi:10.14740/cr724w

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…For all‐cause death, there were seven observational studies contributing to the analysis, published between 2009 and 2020. 10 , 18 , 25 , 38 , 39 , 40 One study from this set reporting outcomes from the Duke Databank for Cardiovascular Disease found that death rates were lower in patients treated with sotalol versus amiodarone or no AAD. 25 Four of these observational studies comprised large national database data sets from Sweden, 10 , 18 Denmark, 38 and South Korea.…”

Section: Discussionmentioning

confidence: 99%

Dronedarone versus sotalol in patients with atrial fibrillation: A systematic literature review and network meta‐analysis

Singh

Blomström‐Lundqvist

Turakhia

et al. 2023

Clinical Cardiology

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Background There are limited comparative data on safety and efficacy within commonly used Vaughan‐Williams (VW) class III antiarrhythmic drugs (AADs) for maintenance of sinus rhythm in adults with atrial fibrillation (AF). Hypothesis We hypothesized that dronedarone and sotalol, two commonly prescribed VW class III AADs with class II properties, have different safety and efficacy effects in patients with nonpermanent AF. Methods A systematic literature review was conducted searching MEDLINE®, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) up to June 15, 2021 (NCT05279833). Clinical trials and observational studies that evaluated safety and efficacy of dronedarone or sotalol in adults with AF were included. Bayesian random‐effects network meta‐analysis (NMA) was used to quantify comparative safety and efficacy. Where feasible, we performed sensitivity analyses by including only randomized controlled trials (RCTs). Results Of 3581 records identified through database searches, 37 unique studies (23 RCTs, 13 observational studies, and 1 nonrandomized trial) were included in the NMA. Dronedarone was associated with a statistically significantly lower risk of all‐cause death versus sotalol (hazard ratio [HR] = 0.38 [95% credible interval, CrI: 0.19, 0.74]). The association was numerically similar in the sensitivity analysis (HR = 0.46 [95% CrI: 0.21, 1.02]). AF recurrence and cardiovascular death results were not significantly different between dronedarone and sotalol in all‐studies and sensitivity analyses. Conclusion The NMA findings indicate that, across all clinical trials and observational studies included, dronedarone compared with sotalol was associated with a lower risk of all‐cause death, but with no difference in AF recurrence.

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Section: Discussionmentioning

confidence: 99%

Dronedarone versus sotalol in patients with atrial fibrillation: A systematic literature review and network meta‐analysis

Singh

Blomström‐Lundqvist

Turakhia

et al. 2023

Clinical Cardiology

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“…Hence, extrapolating data of these trials in the current population of patients with AF who may have various CIEDs may be subjected to further scrutiny. Remote monitoring of CIEDs has become a normal and essential component of the standard of care in patients with cardiac arrhythmias [ 13 – 16 ]. We have previously reported the utility of the technology in optimizing antiarrhythmic and anticoagulation therapy, including the safe withdrawal of long-term oral anticoagulation in some AF patients with a high risk of bleeding [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Outpatient initiation of dofetilide: insights from the complexities of atrial fibrillation management during the COVID-19 lockdown

Mascarenhas

Mudumbi

Kantharia

2021

J Interv Card Electrophysiol

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Background At peak COVID-19 lockdown, patients with symptomatic atrial fibrillation (AF) were faced with an equipoise between a palliative rate-control versus cautious rhythm-control strategy, including hospitalization for initiation of antiarrhythmic drug/s (AADs) and cardiac procedures which was impossible due to hospitalization restrictions. Objectives We aimed to evaluate the efficacy and safety of outpatient initiation of dofetilide in patients with AF using cardiac implantable electronic devices (CIEDs) for rhythm and QTc interval monitoring. Methods Adult patients with symptomatic AF with prior failure or intolerance to other AADs were enrolled if they were willing to in-office insertion of implantable loop recorders or already implanted with pacemakers or defibrillators capable of remote monitoring. Exclusion criteria were known medical contraindications of dofetilide and unable to provide consent. After making a shared management decision, dofetilide was initiated in a physician office, and rhythm and QTc intervals were monitored by ECGs and CIEDs. Patients were followed to assess the efficacy and safety of the treatment. Results The study cohort comprised of 30 patients, age 76 ± 7 years (mean ± standard deviation), 10 female (33%), CHA 2 DS 2 -VASc score 3.25 ± 1.3, ejection fraction 63.45% ± 8.52, and QTc interval 431.68 ± 45.09 ms. From 22 (73%) patients in AF at presentation, SR was restored in 14 (64%) patients after 4 doses of dofetilide. At 46 ± 59 days of follow-up, maintenance of SR in total 22 (73%) patients without cardiac adverse effects was accomplished. Conclusion Effective and safe outpatient initiation of dofetilide during the extenuating circumstance of COVID-19 lockdown was possible in patients with AF who had CIEDs.

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“…[12]. Remote monitoring of CIEDs has become a normal and essential component of standard of care in patients with cardiac arrhythmias [13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Outpatient Initiation of Sotalol in Patients with Atrial Fibrillation: Utility of Cardiac Implantable Electronic Devices for Therapy Monitoring

Mascarenhas

Mudumbi

Kantharia

2021

Am J Cardiovasc Drugs

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Background Antiarrhythmic drugs are often used in the management of patients with atrial fibrillation (AF). Sotalol is conventionally initiated in the inpatient setting for monitoring efficacy and adverse effects, including QTc interval prolongation and torsades de pointes (TdP) proarrhythmia. Objective We aimed to evaluate the efficacy and safety of outpatient initiation of sotalol for the treatment of AF in a select group of patients with cardiac implantable electronic devices (CIEDs): permanent pacemakers (PPMs), implantable cardioverter defibrillators (ICDs), and implantable loop recorders (ILRs) capable of continuous rhythm monitoring remotely. Methods We conducted our clinical study in a real-world practice setting with longitudinal follow-up of the study cohort. We included adult patients with symptomatic paroxysmal and persistent AF eligible for sotalol for rhythm control strategy and who had CIEDs in our study. Patients with a known contraindication to sotalol were excluded. After making a shared management decision with patients, sotalol was initiated as an outpatient, with regular clinical encounters with patients to assess the efficacy and safety of treatment, and monitoring cardiac rhythm and QTc intervals with CIEDs utilizing their remote monitoring platforms. ResultsThe study cohort comprised 105 patients; 38 (36%) females, mean age ± standard deviation (SD) 73.9 ± 10.36 years, and with a CHA 2 DS 2 -VASc score of 3.26 ± 1.37 and left ventricular ejection fraction of 60.16 ± 9.10%. Twenty-six (24.8%) patients were implanted with PPMs, 10 (9.5%) with dual-chamber ICDs, and 69 (65.7%) with ILRs. Over a follow-up period of 23 ± 15 months, sotalol was continued at a steady median dose of 80 mg twice daily, 105 ± 42 mg (mean ± SD) in 77 (73%) patients who maintained sinus rhythm, and discontinued in 28 (27%) patients because of inefficacy or development of adverse effects. No adverse effects relating to QTc prolongation and TdP or mortality were observed during the study period. Conclusions Effective and safe outpatient initiation and maintenance of sotalol therapy is possible in select patients who have CIEDs for continuous remote monitoring and surveillance capabilities.

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Revisiting the Role of Antiarrhythmic Drugs in Prevention of Atrial Fibrillation Recurrence: A Single Center Retrospective Review

Cited by 3 publications

References 24 publications

Dronedarone versus sotalol in patients with atrial fibrillation: A systematic literature review and network meta‐analysis

Dronedarone versus sotalol in patients with atrial fibrillation: A systematic literature review and network meta‐analysis

Outpatient initiation of dofetilide: insights from the complexities of atrial fibrillation management during the COVID-19 lockdown

Outpatient Initiation of Sotalol in Patients with Atrial Fibrillation: Utility of Cardiac Implantable Electronic Devices for Therapy Monitoring

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