1
|
Karwowski J, Wrzosek K, Mączyńska-Mazuruk R, Szmarowska K, Rekosz J, Wiktorska A, Mierzejewska B, Solecki M, Dłużniewski M. Efficacy and safety of antazoline vs propafenone for conversion of paroxysmal atrial fibrillation to sinus rhythm: a randomized, double-blind study (AnProAF). Pol Arch Intern Med 2024; 134:16657. [PMID: 38166357 DOI: 10.20452/pamw.16657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
INTRODUCTION Antazoline is a frequently used antiarrhythmic drug (AAD); however, to date, no randomized controlled trial has evaluated its efficacy and safety for cardioversion of recent‑onset atrial fibrillation (AF) in comparison with other approved AADs. OBJECTIVES This study aimed to compare clinical efficacy and safety of antazoline and propafenone for a rapid conversion of nonvalvular paroxysmal AF to sinus rhythm in patients without heart failure. PATIENTS AND METHODS This was a single‑center, randomized, double‑blind study. It included patients with AF (lasting <48 hours) who were in a stable cardiopulmonary condition and eligible for cardioversion. The individuals who fulfilled the inclusion criteria were randomly assigned to receive either antazoline (up to 300 mg) or propafenone (up to 140 mg) intravenously. The primary end point was conversion of AF to sinus rhythm confirmed on electrocardiography. RESULTS Overall, 94 participants (46 [48.9%] in the antazoline group and 48 [51.1%] in the propafenone group) were included. The mean (SD) age was 67.5 (14) years, and 40 participants (42.5%) were men. Successful AF conversion was observed in 29 patients (63%) from the antazoline group and 25 individuals (52.1%) from the propafenone group (P = 0.39). The median time to conversion was 10 minutes in the antazoline group and 30 minutes in the propafenone group (P = 0.03). Severe adverse events were observed in 5 patients (10.8%) treated with antazoline and 5 individuals (10.4%) who received propafenone. CONCLUSIONS Intravenous antazoline demonstrated efficacy and safety comparable to those of intravenous propafenone for acute conversion of nonvalvular paroxysmal AF to sinus rhythm in patients without heart failure.
Collapse
Affiliation(s)
- Jarosław Karwowski
- Department of Heart Diseases, Medical Centre of Postgraduate Education, Warsaw, Poland.
| | - Karol Wrzosek
- Department of Heart Diseases, Medical Centre of Postgraduate Education, Warsaw, Poland
| | | | | | - Jerzy Rekosz
- Second Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Anna Wiktorska
- Second Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Beata Mierzejewska
- Second Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Mateusz Solecki
- Second Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Mirosław Dłużniewski
- Department of Heart Diseases, Medical Centre of Postgraduate Education, Warsaw, Poland
| |
Collapse
|
2
|
Rekosz J, Karwowski J, Kowalik I, Wiktorska A, Wrzosek K, Solecki M, Szmarowska K, Szymańska A, Mierzejewska B, Syska-Sumińska J, Dłużniewski M. Risk factors for thrombus and spontaneous echocardiographic contrast with sludge among atrial fibrillation patients treated with oral anticoagulants before electrical cardioversion. Kardiol Pol 2024:VM/OJS/J/100078. [PMID: 38606742 DOI: 10.33963/v.phj.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Jerzy Rekosz
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland.
| | - Jarosław Karwowski
- Department of Heart Diseases, Postgraduate Medical School, Warszawa, Poland
| | - Ilona Kowalik
- National Institute of Cardiology. Clinical Research Support Center, Warszawa, Poland
| | - Anna Wiktorska
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland
| | - Karol Wrzosek
- Department of Heart Diseases, Postgraduate Medical School, Warszawa, Poland
| | - Mateusz Solecki
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland
| | | | - Anna Szymańska
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland
| | - Beata Mierzejewska
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland
| | | | | |
Collapse
|
3
|
Karwowski J, Wrzosek K, Rekosz J, Tymoszuk K, Wiktorska A, Szmarowska K, Solecki M, Dłużniewski M. Electric Cardioversion in Older Adults. Is Sedation Using Propofol Safe in the Absence of the Direct Anesthetist's Assistance? J Cardiovasc Pharmacol Ther 2024; 29:10742484231221929. [PMID: 38291723 DOI: 10.1177/10742484231221929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Aims: This study aimed to assess the safety of electric cardioversion in the absence of anesthetists assistance. We also evaluated the efficacy and safety of this procedure in older adults (≥80 years) compared to younger populations. Methods: We retrospectively analyzed the data of patients who underwent electric cardioversion at our cardiology department. Patients were divided into 2 groups according to age: ≥ 80 years and <80 years old. Results: The study included 218 participants, 73 were aged 80 years or more (mean age: 84.8 years), and 145 were younger than 80 years (mean age: 66.7 years). Electric cardioversion was effective in 97.3% of older patients and 96.5% of younger patients (P = 1.00). No thromboembolic complications were observed in either of the groups. Asystole >5 s occurred immediately after shock in 4.1% of older and 2.1% of younger patients (P = .405). Propofol was used as a sedative, with a mean dose of 0.83 mg/kg versus 0.93 mg/kg, in older and younger patients, respectively. Intubation, medical intervention, or other advanced resuscitation techniques were not required. During hospitalization, arrhythmia recurred in 9.6% and 12.4% of the older and younger patients, respectively (P = .537). Conclusions: Electrical cardioversion is an effective and safe procedure regardless of patient age. Sedation with propofol administered by cardiologists was safe. Adverse events were not considered serious or reversible.
Collapse
Affiliation(s)
- Jarosław Karwowski
- Department of Heart Diseases, Medical Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Karol Wrzosek
- Department of Heart Diseases, Medical Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jerzy Rekosz
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Katarzyna Tymoszuk
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Anna Wiktorska
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | | | - Mateusz Solecki
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Mirosław Dłużniewski
- Department of Heart Diseases, Medical Centre of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
4
|
Wybraniec MT, Mizia‐Szubryt M, Cichoń M, Wrona‐Kolasa K, Kapłon‐Cieślicka A, Gawałko M, Budnik M, Uziębło‐Życzkowska B, Krzesiński P, Starzyk K, Gorczyca‐Głowacka I, Daniłowicz‐Szymanowicz L, Kaufmann D, Wójcik M, Błaszczyk R, Hiczkiewicz J, Łojewska K, Kosmalska K, Fijałkowski M, Szymańska A, Wiktorska A, Haberka M, Kucio M, Michalski B, Kupczyńska K, Tomaszuk‐Kazberuk A, Wilk‐Śledziewska K, Wachnicka‐Truty R, Koziński M, Burchardt P, Mizia‐Stec K. Heart failure and the risk of left atrial thrombus formation in patients with atrial fibrillation or atrial flutter. ESC Heart Fail 2022; 9:4064-4076. [PMID: 36039813 PMCID: PMC9773653 DOI: 10.1002/ehf2.14105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transoesophageal echocardiography (TOE) in patients with atrial fibrillation or atrial flutter (AF/AFl) with reference to the presence of heart failure (HF) and its subtypes. METHODS AND RESULTS The research is a sub-study of the multicentre, prospective, observational Left Atrial Thrombus on Transoesophageal Echocardiography (LATTEE) registry, which comprised 3109 consecutive patients with AF/AFl undergoing TOE prior to direct current cardioversion or catheter ablation. TOE parameters, including presence of LAT, were compared between patients with and without HF and across different subtypes of HF, including HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF). HF was diagnosed in 1336 patients (43%). HF patients had higher prevalence of LAT than non-HF patients (12.8% vs. 4.4%; P < 0.001). LAT presence increased with more advanced type of systolic dysfunction (HFpEF vs. HFmrEF vs. HFrEF: 7.4% vs. 10.5% vs. 20.3%; P < 0.001). Univariate analysis revealed that HFrEF (odds ratio [OR] 4.13; 95% confidence interval [95% CI]: 3.13-5.46), but not HFmrEF or HFpEF, was associated with the presence of LAT. Multivariable logistic regression indicated that lower left ventricular ejection fraction (OR per 1%: 0.94; 95% CI 0.93-0.95) was an independent predictor of LAT formation. Receiver operator characteristic analysis showed LVEF ≤48% adequately predicted increased risk of LAT presence (area under the curve [AUC] 0.74; P < 0.0001). CONCLUSION The diagnosis of HFrEF, but neither HFmrEF nor HFpEF, confers a considerable risk of LAT presence despite widespread utilization of adequate anticoagulation.
Collapse
Affiliation(s)
- Maciej T. Wybraniec
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland,Members of the European Reference Network on Heart diseases ‐ ERN GUARD‐HEARTAmsterdamNetherlands
| | - Magdalena Mizia‐Szubryt
- First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Małgorzata Cichoń
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Karolina Wrona‐Kolasa
- First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Agnieszka Kapłon‐Cieślicka
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Chair and Department of CardiologyMedical University of WarsawWarsawPoland
| | - Monika Gawałko
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Chair and Department of CardiologyMedical University of WarsawWarsawPoland,Department of CardiologyMaastricht University Medical Centre and Cardiovascular Research Institute MaastrichtMaastrichtThe Netherlands,Institute of Pharmacology, West German Heart and Vascular CentreUniversity of Duisburg‐EssenDuisburgGermany
| | - Monika Budnik
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Chair and Department of CardiologyMedical University of WarsawWarsawPoland
| | | | - Paweł Krzesiński
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology and Internal DiseasesMilitary Institute of MedicineWarsawPoland
| | - Katarzyna Starzyk
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre; Collegium MedicumThe Jan Kochanowski UniversityKielcePoland
| | - Iwona Gorczyca‐Głowacka
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre; Collegium MedicumThe Jan Kochanowski UniversityKielcePoland
| | | | - Damian Kaufmann
- Department of Cardiology and ElectrotherapyMedical University of GdańskGdańskPoland
| | - Maciej Wójcik
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of LublinLublinPoland
| | - Robert Błaszczyk
- Department of CardiologyMedical University of LublinLublinPoland
| | - Jarosław Hiczkiewicz
- Clinical Department of CardiologyNowa Sól Multidisciplinary HospitalNowa SólPoland,University of Zielona GóraZielona GóraPoland
| | - Katarzyna Łojewska
- Clinical Department of CardiologyNowa Sól Multidisciplinary HospitalNowa SólPoland
| | | | - Marcin Fijałkowski
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Department of CardiologyMedical University of GdanskGdańskPoland
| | - Anna Szymańska
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Heart DiseasesPostgraduate Medical SchoolWarsawPoland
| | - Anna Wiktorska
- Department of Heart DiseasesPostgraduate Medical SchoolWarsawPoland
| | - Maciej Haberka
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology, School of Health SciencesMedical University of SilesiaKatowicePoland
| | - Michał Kucio
- Department of Cardiology, School of Health SciencesMedical University of SilesiaKatowicePoland
| | - Błażej Michalski
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of LódżŁódźPoland
| | - Karolina Kupczyńska
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of LódżŁódźPoland
| | - Anna Tomaszuk‐Kazberuk
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of BiałystokBiałystokPoland
| | | | - Renata Wachnicka‐Truty
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology and Internal MedicineMedical University of GdańskGdyniaPoland
| | - Marek Koziński
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology and Internal MedicineMedical University of GdańskGdyniaPoland
| | - Paweł Burchardt
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Biology and Lipid DisordersPoznań University of Medical SciencesPoznańPoland
| | - Katarzyna Mizia‐Stec
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland,Members of the European Reference Network on Heart diseases ‐ ERN GUARD‐HEARTAmsterdamNetherlands
| |
Collapse
|
5
|
Karwowski J, Rekosz J, Mączyńska-Mazuruk R, Wiktorska A, Wrzosek K, Loska W, Szmarowska K, Solecki M, Sumińska-Syska J, Dłużniewski M. Left atrial appendage thrombus in patients with atrial fibrillation who underwent oral anticoagulation. Cardiol J 2022:VM/OJS/J/88275. [PMID: 35703043 DOI: 10.5603/cj.a2022.0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/07/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Electric cardioversion of atrial fibrillation (AF) is associated with an increased risk of embolism, with embolic material existing in the heart cavities. The initiation of oral anticoagulation therapy reduces the risk of thromboembolic events. The aims of this study were to evaluate the prevalence of left atrial appendage (LAA) thrombi in non-valvular AF, to compare vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulants (NOACs) with respect to thrombus prevalence, and to evaluate the rate of LAA thrombus persistence on repeat transesophageal echocardiography (TEE) after treatment change. METHODS We enrolled 160 consecutive AF patients who presented with an AF duration > 48 h and had undergone TEE before cardioversion. RESULTS Left atrial appendage thrombus was observed in 12 (7.5%) patients, and spontaneous echo contrast 4 was observed in 19 (11.8%) patients; the incidence was similar between the NOAC and VKA groups (8.9% vs. 3.6% and 12.4% vs. 18.5 %, respectively). Among patients on NOAC, thrombus prevalence was detected in 8.4% of users of rivaroxaban, 8% of users of dabigatran, and 12.5% of users of apixaban. CONCLUSIONS The LAA thrombus developed in 7.5% of patients despite anticoagulation therapy, demonstrating similar prevalence rates among patients either on NOAC or VKA. Lower mean LAA flow velocity and a history of vascular disease were independent predictors of embolic material in the LAA. It seems that in the case of embolic materials in LAA under NOAC treatment, switching to VKA provides additional clinical benefit to the patients.
Collapse
Affiliation(s)
- Jarosław Karwowski
- Department of Heart Diseases, Medical Center of Postgraduate Education, Warsaw, Poland.
| | - Jerzy Rekosz
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | | | - Anna Wiktorska
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Karol Wrzosek
- Department of Heart Diseases, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Wioletta Loska
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | | | - Mateusz Solecki
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Joanna Sumińska-Syska
- Department of Heart Diseases, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Mirosław Dłużniewski
- Department of Heart Diseases, Medical Center of Postgraduate Education, Warsaw, Poland
| |
Collapse
|