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Klocek K, Tworek M, Klimek K, Zabochnicki M, Mazur M, Milewski K, Kaźmierczak P, Janas A. Comparison of efficacy of pharmacological cardioversion with antazoline and propafenone versus electrical cardioversion in atrial fibrillation during cryoablation. Postepy Kardiol Interwencyjnej 2024; 20:103-108. [PMID: 38616946 PMCID: PMC11008507 DOI: 10.5114/aic.2024.136392] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/16/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Antazoline with propafenone may be an alternative to electrical cardioversion (ECV) in restoring sinus rhythm in patients with atrial fibrillation (AF), including during balloon cryoablation. Aim To compare the efficacy of antazoline with propafenone and ECV in restoring and maintaining sinus rhythm at discharge in patients with AF during cryoablation with special regard to type of AF. Material and methods The study retrospectively analyzed 196 patients who underwent elective cryoablation. Eighty-nine patients who developed AF in the perioperative period were selected as the study group (32 women and 57 men). The study group was divided into two groups - 46 (51.7%) patients were given pharmacological cardioversion with 70 mg of propafenone and 100 or 200 mg of antazoline, whereas the other 43 (48.3%) patients underwent ECV. Results There were no statistically significant differences between the groups regarding: left atrial area, left atrium diameter, right atrial area and right atrium diameter. In the overall population, ECV was more effective than antazoline with propafenone therapy (31 [72.1%] vs. 20 [43.5%]; p = 0.01). A similar relationship was demonstrated in patients with persistent AF (13 [59.1%] vs. 3 [12.5%]; p = 0.002). There was no significant difference in the group of patients with paroxysmal AF (18 (85.6%) vs. 17 (77.3%); p = 0.7). Conclusions In AF during the cryoablation procedure ECV appears to be more effective in restoring and maintaining sinus rhythm at discharge than antazoline with propafenone in the general AF patient population, especially in patients with persistent AF.
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Affiliation(s)
- Konrad Klocek
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Michał Tworek
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Katarzyna Klimek
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Mateusz Zabochnicki
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Marta Mazur
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Krzysztof Milewski
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Paweł Kaźmierczak
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Adam Janas
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
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Hussein OG, Ahmed DA, Abdelkawy M, Rezk MR, Rostom Y. A novel green spectrofluorimetric method for simultaneous determination of antazoline and tetryzoline in their ophthalmic formulation. LUMINESCENCE 2024; 39:e4728. [PMID: 38516711 DOI: 10.1002/bio.4728] [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] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/31/2024] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
A novel spectrofluorimetric method has been developed for determination of antazoline (ANT) and tetryzoline (TET) in their pharmaceutical formulation. A combined application of synchronous spectrofluorimetry and second derivative mathematical treatment was developed. The proposed method depends on reacting the cited drugs with dansyl chloride (DNS-Cl) being a suitable derivatizing agent generating highly fluorescent derivatives measured at emission wavelengths of 703.0 and 642.0 nm after excitation wavelengths of 350.0 and 320.0 nm for ANT and TET, respectively. The joint use of synchronous spectrofluorimetry with second derivative mathematical treatment is for the first time to be developed and optimized in aid of using fluorescence data manager software generating second derivative peak amplitudes at 556.5 nm for ANT and 516.7 nm for TET. Linear responses have been represented over a wide range of concentration (0.5-12.0 μg/mL for ANT and 0.5-10.0 μg/mL for TET). Additionally, statistical comparison of the developed method with the official ones has been carried out where no significant difference was found. Additionally, greenness profile assessment was accomplished by means of four metric tools. Indeed, the method developed is found to be precise, sensitive, and discriminating to assess the cited drugs for regular analysis.
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Affiliation(s)
- Ola G Hussein
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Future University in Egypt, Cairo, 11835, Egypt
| | - Dina A Ahmed
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Future University in Egypt, Cairo, 11835, Egypt
| | - Mohamed Abdelkawy
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Mamdouh R Rezk
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Yasmin Rostom
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Wybraniec MT, Maciąg A, Miśkowiec D, Ceynowa-Sielawko B, Balsam P, Wójcik M, Wróbel W, Farkowski M, Ćwiek-Rębowska E, Szołkiewicz M, Ozierański K, Błaszczyk R, Bula K, Dembowski T, Peller M, Krzowski B, Wyganowska-Kapryan A, Wańha W, Koziński M, Kasprzak JD, Szwed H, Mizia-Stec K. Antiarrhythmic drugs for pharmacological cardioversion of atrial fibrillation and sex differences: Insights from the CANT II Study. Kardiol Pol 2023; 81:1089-1095. [PMID: 37997824 DOI: 10.33963/v.kp.97392] [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] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 11/25/2023]
Abstract
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 CHA2DS2-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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Affiliation(s)
- Maciej T Wybraniec
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Centre, Katowice, Poland.
- European Reference Network on Heart Diseases-ERN GUARD-HEART, Amsterdam, The Netherlands.
- Club 30' of the Polish Cardiac Society.
| | - Aleksander Maciąg
- 2nd Department of Heart Arrhythmia, National Institute of Cardiology, Warszawa, Poland
| | - Dawid Miśkowiec
- Department of Cardiology, Medical University of Lodz, Łódź, Poland
- Club 30' of the Polish Cardiac Society
| | - Beata Ceynowa-Sielawko
- Department of Cardiology and Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, Wejherowo, Poland
| | - Paweł Balsam
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
- Club 30' of the Polish Cardiac Society
| | - Maciej Wójcik
- Chair and Department of Cardiology, Medical University of Lublin, Lublin, Poland
- Club 30' of the Polish Cardiac Society
| | - Wojciech Wróbel
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Centre, Katowice, Poland
| | - Michał Farkowski
- 2nd Department of Heart Arrhythmia, National Institute of Cardiology, Warszawa, Poland
- Club 30' of the Polish Cardiac Society
| | | | - Marek Szołkiewicz
- Department of Cardiology and Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, Wejherowo, Poland
| | - Krzysztof Ozierański
- Club 30' of the Polish Cardiac Society
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Robert Błaszczyk
- Club 30' of the Polish Cardiac Society
- Chair and Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Karolina Bula
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Centre, Katowice, Poland
| | - Tomasz Dembowski
- Department of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Michał Peller
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Bartosz Krzowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | | | - Wojciech Wańha
- Club 30' of the Polish Cardiac Society
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Upper Silesia Medical Center, Katowice, Poland
| | - Marek Koziński
- Club 30' of the Polish Cardiac Society
- Department of Cardiology and Internal Medicine, Medical University of Gdańsk, Gdynia, Poland
| | - Jarosław D Kasprzak
- Club 30' of the Polish Cardiac Society
- Department of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Hanna Szwed
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warszawa, Poland
| | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Centre, Katowice, Poland
- European Reference Network on Heart Diseases-ERN GUARD-HEART, Amsterdam, The Netherlands
- Club 30' of the Polish Cardiac Society
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Ceynowa-Sielawko B, Wybraniec MT, Topp-Zielińska A, Maciąg A, Miśkowiec D, Balsam P, Wójcik M, Wróbel W, Farkowski MM, Ćwiek-Rębowska E, Ozierański K, Błaszczyk R, Bula K, Dembowski T, Peller M, Krzowski B, Wańha W, Koziński M, Kasprzak JD, Szwed H, Mizia-Stec K, Szołkiewicz M. Pharmacological Cardioversion in Patients with Recent-Onset Atrial Fibrillation and Chronic Kidney Disease Subanalysis of the CANT II Study. Int J Environ Res Public Health 2022; 19. [PMID: 35457747 DOI: 10.3390/ijerph19084880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023]
Abstract
Pharmacological cardioversion (PCV) is commonly a primary option for termination of recent-onset atrial fibrillation (AF) in emergency departments (ED). This is a subanalysis of the CANT II study, evaluating the effectiveness and safety of antazoline in patients (n = 777) at three stages of chronic kidney disease (CKD): Group I > 60 mL/min (n = 531), Group II 45−59 mL/min (n = 149), and Group III < 45 mL/min (n = 97). Patients in Group III were older and with a higher prevalence of co-morbidities; however, we did not find statistically significant differences in the overall effectiveness of PCV in comparison with the other groups. In patients receiving amiodarone, the PCV success rate was similar in all the studied groups, but along with a renal function decline, it decreased in patients receiving antazoline (79.1 vs. 35%; p < 0.001), and it increased almost significantly in patients receiving propafenone (69.9 vs. 100%; p = 0.067). In patients in Group I, antazoline restored a sinus rhythm as effectively as propafenone and amiodarone; however, in patients in Group III, both antazoline and amiodarone became less effective in restoring a sinus rhythm than propafenone (p = 0.002 and p = 0.034, respectively). The rate of safety endpoint was the highest in patients in Group III (eGFR < 45 mL/min), and it was significantly higher than in patients in Groups I and II (p = 0.008 and p = 0.036, respectively). We did not observe antazoline-related adverse events in any of the studied groups of patients. This real-world registry analysis revealed a different influence of CKD on the effectiveness of individual drugs, and while propafenone and amiodarone maintained their AF termination efficacy, antazoline became significantly less effective in restoring sinus rhythm.
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Giebułtowicz J, Korytowska N, Sobiech M, Polak S, Wiśniowska B, Piotrowski R, Kułakowski P, Luliński P. Magnetic Core-Shell Molecularly Imprinted Nano-Conjugates for Extraction of Antazoline and Hydroxyantazoline from Human Plasma-Material Characterization, Theoretical Analysis and Pharmacokinetics. Int J Mol Sci 2021; 22:ijms22073665. [PMID: 33915912 PMCID: PMC8038096 DOI: 10.3390/ijms22073665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 01/28/2023] Open
Abstract
The aim of this study was to develop magnetic molecularly imprinted nano-conjugate sorbent for effective dispersive solid phase extraction of antazoline (ANT) and its metabolite, hydroxyantazoline (ANT-OH) in analytical method employing liquid chromatography coupled with mass spectrometry method. The core–shell material was characterized in terms of adsorption properties, morphology and structure. The heterogeneous population of adsorption sites towards ANT-OH was characterized by two Kd and two Bmax values: Kd (1) = 0.319 µg L−1 and Bmax (1) = 0.240 μg g−1, and Kd (2) = 34.6 µg L−1 and Bmax (2) = 5.82 μg g−1. The elemental composition of magnetic sorbent was as follows: 17.55, 37.33, 9.14, 34.94 wt% for Si, C, Fe and O, respectively. The extraction protocol was optimized, and the obtained results were explained using theoretical analysis. Finally, the analytical method was validated prior to application to pharmacokinetic study in which the ANT was administrated intravenously to three healthy volunteers. The results prove that the novel sorbent could be useful in extraction of ANT and ANT-OH from human plasma and that the analytical strategy could be a versatile tool to explain a potential and pharmacological activity of ANT and ANT-OH.
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Affiliation(s)
- Joanna Giebułtowicz
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland;
- Correspondence:
| | - Natalia Korytowska
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland;
| | - Monika Sobiech
- Department of Organic Chemistry, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland; (M.S.); (P.L.)
| | - Sebastian Polak
- Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (S.P.); (B.W.)
| | - Barbara Wiśniowska
- Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (S.P.); (B.W.)
| | - Roman Piotrowski
- Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, 04-073 Warsaw, Poland; (R.P.); (P.K.)
| | - Piotr Kułakowski
- Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, 04-073 Warsaw, Poland; (R.P.); (P.K.)
| | - Piotr Luliński
- Department of Organic Chemistry, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland; (M.S.); (P.L.)
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Giebułtowicz J, Korytowska N, Piotrowski R, Kułakowski P, Latacz G, Szymańska E, Wiśniowska B, Polak S. Characterization of In Vitro and In Vivo Metabolism of Antazoline Using Liquid Chromatography-Tandem Mass Spectrometry. Int J Mol Sci 2020; 21:ijms21249693. [PMID: 33353167 PMCID: PMC7766522 DOI: 10.3390/ijms21249693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 02/03/2023] Open
Abstract
Antazoline (ANT) was recently shown to be an effective and safe antiarrhythmic drug in the termination of atrial fibrillation. However, the drug is still not listed in clinical guidelines. No data on ANT metabolism in humans is available. We used liquid chromatography coupled with tandem mass spectrometry to identify and characterize metabolites of ANT. We analyzed plasma of volunteers following a single intravenous administration of 100 mg of ANT mesylate and in in vitro cultures of human hepatocytes. We revealed that ANT was transformed into at least 15 metabolites and we investigated the role of cytochrome P450 isoforms. CYP2D6 was the main one involved in the fast metabolism of ANT. The biotransformation of ANT by CYP2C19 was much slower. The main Phase I metabolite was M1 formed by the removal of phenyl and metabolite M2 with hydroxyl in the para position of phenyl. Glucuronidation was the leading Phase II metabolism. Further study on pharmacokinetics of the metabolites would allow us to better understand the activity profile of ANT and to predict its potential clinical applications. Ultimately, further investigation of the activity profile of the new hydroxylated M2 metabolite of ANT might result in an active substance with a different pharmacological profile than the parent molecule, and potentially a new drug candidate.
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Affiliation(s)
- Joanna Giebułtowicz
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland;
- Correspondence:
| | - Natalia Korytowska
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland;
| | - Roman Piotrowski
- Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, 04-073 Warsaw, Poland; (R.P.); (P.K.)
| | - Piotr Kułakowski
- Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, 04-073 Warsaw, Poland; (R.P.); (P.K.)
| | - Gniewomir Latacz
- Department of Technology and Biotechnology of Drugs, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (G.L.); (E.S.)
| | - Ewa Szymańska
- Department of Technology and Biotechnology of Drugs, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (G.L.); (E.S.)
| | - Barbara Wiśniowska
- Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (B.W.); (S.P.)
| | - Sebastian Polak
- Department of Social Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (B.W.); (S.P.)
- Certara UK Limited, Simcyp Division, Sheffield S1 2BJ, UK
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Abstract
Background Antazoline mesylate represents an antihistamine capable of rapid and safe cardioversion of atrial fibrillation, yet evidence concerning its efficacy in comparison to other medications is insufficient. The study aimed to evaluate the success rate and safety of pharmacological cardioversion of atrial fibrillation with intravenous antazoline ( CANT [Cardioversion With Antazoline Mesylate] study) in the setting of the emergency department. Methods and Results After reviewing 1984 medical records, 450 eligible patients (22.7%) with short-duration atrial fibrillation subject to pharmacological cardioversion were enrolled in a retrospective observational analysis. The choice of antiarrhythmic drug was left to the discretion of the attending physician. The primary end point was successful cardioversion in the emergency department. The safety end point comprised bradycardia <45 bpm, hypotension, syncope, or death. The study population (mean age, 65.5±11.9 years; 52.9% females) was characterized by a median atrial fibrillation episode duration of 10 hours. Antazoline, alone or in combination, was administered in 24.2% (n=109) and 40% (n=180), respectively; amiodarone was administered in 46.7% and propafenone in 9.3%, while ≥2 antiarrhythmic drugs were administered in 19.8% of patients. Antazoline had the highest success rate of pharmacological cardioversion among all drugs (85.3%), which was comparable with propafenone (78.6%; relative risk, 1.09, 95% confidence interval, 0.91-1.30; P=0.317) and higher than amiodarone treatment (66.7%; relative risk, 1.28, 95% confidence interval, 1.13-1.45; P<0.001; number needed to treat, 5.4). The rate of cardioversion with antazoline alone was higher than combined amiodarone and/or propafenone (68.1%; relative risk, 1.25; 95% confidence interval, 1.12-1.40, P=0.0001). No safety end points were reported in the antazoline group, while 5 incidents occurred in the non-antazoline cohort ( P=0.075). Conclusions Antazoline represents an efficacious and safe method of pharmacological cardioversion in a real-life setting.
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Affiliation(s)
- Maciej T Wybraniec
- 1 First Department of Cardiology School of Medicine in Katowice Medical University of Silesia Katowice Poland.,2 Upper Silesia Medical Center Katowice Poland
| | - Wojciech Wróbel
- 1 First Department of Cardiology School of Medicine in Katowice Medical University of Silesia Katowice Poland.,2 Upper Silesia Medical Center Katowice Poland
| | - Katarzyna Wilkosz
- 1 First Department of Cardiology School of Medicine in Katowice Medical University of Silesia Katowice Poland.,2 Upper Silesia Medical Center Katowice Poland
| | - Karolina Wrona
- 1 First Department of Cardiology School of Medicine in Katowice Medical University of Silesia Katowice Poland.,2 Upper Silesia Medical Center Katowice Poland
| | - Karolina Bula
- 1 First Department of Cardiology School of Medicine in Katowice Medical University of Silesia Katowice Poland.,2 Upper Silesia Medical Center Katowice Poland
| | - Katarzyna Mizia-Stec
- 1 First Department of Cardiology School of Medicine in Katowice Medical University of Silesia Katowice Poland.,2 Upper Silesia Medical Center Katowice Poland
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Farkowski MM, Maciag A, Kowalik I, Konka M, Szwed H, Pytkowski M. Intravenous antazoline, a first-generation antihistaminic drug with antiarrhythmic properties, is a suitable agent for pharmacological cardioversion of atrial fibrillation induced during pulmonary vein isolation due to the lack of influence on atrio-venous conduction and high clinical effectiveness (AntaEP Study). Br J Clin Pharmacol 2019; 85:1552-1558. [PMID: 30920001 DOI: 10.1111/bcp.13940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 10/30/2018] [Revised: 03/07/2019] [Accepted: 03/23/2019] [Indexed: 12/01/2022] Open
Abstract
AIMS Antazoline is a first-generation antihistaminic drug used primarily in eye drop formulations. When administered intravenously, antazoline displays antiarrhythmic properties resulting in a rapid conversion of recent-onset atrial fibrillation (AF) to sinus rhythm (SR). The aim of the study was to assess the influence of antazoline on atrio-venous conduction and other electrophysiological parameters in patients undergoing AF ablation. METHODS An experimental prospective study. Patients scheduled for the first-time AF ablation, in SR and not on amiodarone were enrolled. Atrio-venous conduction assessment and invasive electrophysiological study (EPS) were performed before and after intravenous administration of 250 mg of antazoline. In case of AF induction during EPS, antazoline was administered until conversion to SR or a cumulative dose of 300 mg. RESULTS We enrolled 14 patients: 13 (93%) men, mean age 63.4 (59.9-66.8) years, mean CHA2 DS2 -VASc score 1.6 (1.0-2.2). Antazoline was administered in a mean dose 257.1 (246.7-267.6) mg. Pulmonary vein potentials and atrial capture during pulmonary vein stimulation were present before and after the administration of antazoline. Wenckebach point and atrial conduction times did not change significantly, but atrio-ventricular node effective refractory period improved-324.7 (275.9-373.5) ms vs 284.3 (256.2-312.4) ms, P = 0.02. Antazoline was effective in all 5 (100%) cases of AF induction during EPS. There were no serious adverse events. CONCLUSION Due to the lack of influence on atrio-venous conduction and high clinical effectiveness, antazoline may be suitable for pharmacological cardioversion of AF occurring during AF ablation.
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Affiliation(s)
- Michal M Farkowski
- Department of Coronary Artery Disease, Institute of Cardiology, Alpejska, Warsaw, Poland
| | - Aleksander Maciag
- Department of Coronary Artery Disease, Institute of Cardiology, Alpejska, Warsaw, Poland
| | - Ilona Kowalik
- Department of Coronary Artery Disease, Institute of Cardiology, Alpejska, Warsaw, Poland
| | - Marek Konka
- Department of Congenital Heart Diseases, Institute of Cardiology, Alpejska, Warsaw, Poland
| | - Hanna Szwed
- Department of Coronary Artery Disease, Institute of Cardiology, Alpejska, Warsaw, Poland
| | - Mariusz Pytkowski
- Department of Coronary Artery Disease, Institute of Cardiology, Alpejska, Warsaw, Poland
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Farkowski MM, Maciag A, Zurawska M, Kowalik I, Szwed H, Pytkowski M. Clinical effectiveness and safety of antazoline-based therapy in patients with stable coronary artery disease undergoing pharmacological cardioversion of short-duration atrial fibrillation in the emergency department. Cardiovasc Ther 2018; 36:e12469. [PMID: 30281920 DOI: 10.1111/1755-5922.12469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/20/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Options for a pharmacological cardioversion (CV) of short-duration atrial fibrillation (AF) in patients with a stable coronary artery disease (CAD) are limited to amiodarone or vernakalant. Antazoline has been reported to achieve high rates of AF conversion to sinus rhythm, but data on its effectiveness and, more importantly, safety in stable CAD patients, have been sparse. AIMS To assess the effectiveness and safety of antazoline-based therapy in patients with a stable CAD undergoing pharmacological CV of short-duration AF in the emergency department (ED). RESULTS A retrospective case-control study. We conducted an analysis of medical records of patients with a stable CAD undergoing CV of short duration (≤48 hours) AF in the ED using intravenous antazoline. The main endpoints of the study were successful cardioversion of AF and hospitalization due to the adverse effects (AE) of the treatment. Between 2008 and 2012, out of 548 CVs, antazoline was administered 334 times: 138 in CAD and 196 in the control group. Patients in the CAD group were older and had more comorbidities than controls; 65 patients had had a history of myocardial infarction (MI). In CAD group, the effectiveness was higher (82.6% vs 63.8%, RB: 1.30 [95% CI: 1.14-1.48], P = 0.0002) and the hospitalization rate due to AE was similar (1.4% vs 4.1%, RR: 0.36 [95% CI: 0.08-1.65], P = 0.2054) to the control group. Among patients with CAD, a history of MI did not influence the effectiveness or safety of the CV (P = 0.2252 and P = 1.0000, respectively). CONCLUSIONS In selected patients with a stable CAD, even with a history of MI, antazoline-based CV of short-duration AF may be an effective and safe therapeutic option.
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Affiliation(s)
- Michal M Farkowski
- II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Aleksander Maciag
- II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Malgorzata Zurawska
- II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Ilona Kowalik
- II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Hanna Szwed
- II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Pytkowski
- II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
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Piotrowski R, Giebułtowicz J, Baran J, Sikorska A, Gralak‐Łachowska D, Soszyńska M, Wroczyński P, Kułakowski P. Antazoline-insights into drug-induced electrocardiographic and hemodynamic effects: Results of the ELEPHANT II substudy. Ann Noninvasive Electrocardiol 2017; 22:e12441. [PMID: 28236352 PMCID: PMC6931461 DOI: 10.1111/anec.12441] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Received: 09/19/2016] [Accepted: 12/19/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Antazoline is an old antihistaminic and new antiarrhythmic agent with unknown mechanisms of action which recently has been shown to effectively terminate atrial fibrillation. The aim of study was to examine the effects of antazoline on hemodynamic and ECG parameters. METHODS Antazoline was given intravenously in three 100 mg boluses to 10 healthy volunteers (four males, mean age 40 + 11 years). Hemodynamic and ECG parameters were measured using impedance cardiography [systolic (sBP), diastolic (dBP), mean (mBP) blood pressure, stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and heart rate (HR), P wave, PR interval, QRS complex, QT and corrected QT (QTcF) interval]. Plasma concentration of antazoline was also measured. RESULTS Antazoline caused significant prolongation of P wave, QRS as well as QT and QTcF (101 ± 10 vs 110 ± 16 ms, p < .05, and 101 ± 12 vs 107 ± 12 ms, p < .05, 399 ± 27 vs 444 ± 23 ms, p < .05, and 403 ± 21 vs 448 ± 27 ms, p < .05, respectively). Also, a significant decrease in SV was noted (94.9 ± 21.8 vs 82.4 ± 19.6 ml, p < .05). A significant correlation between changes in plasma drug concentration and changes in CO, HR, and dBP was found. CONCLUSIONS Antazoline impairs slightly hemodynamics, significantly reducing SV. Significant prolongation of P wave and QRS duration corresponds to drug-induced prolongation of conduction, whereas QT prolongation represents drug-induced prolongation of repolarization.
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Affiliation(s)
- Roman Piotrowski
- Department of CardiologyPostgraduate Medical SchoolGrochowski HospitalWarsawPoland
| | - Joanna Giebułtowicz
- Bioanalysis and Drugs Analysis DepartmentFaculty of PharmacyMedical University of WarsawWarsawPoland
| | - Jakub Baran
- Department of CardiologyPostgraduate Medical SchoolGrochowski HospitalWarsawPoland
| | - Agnieszka Sikorska
- Department of CardiologyPostgraduate Medical SchoolGrochowski HospitalWarsawPoland
| | | | - Małgorzata Soszyńska
- Department of CardiologyPostgraduate Medical SchoolGrochowski HospitalWarsawPoland
| | - Piotr Wroczyński
- Bioanalysis and Drugs Analysis DepartmentFaculty of PharmacyMedical University of WarsawWarsawPoland
| | - Piotr Kułakowski
- Department of CardiologyPostgraduate Medical SchoolGrochowski HospitalWarsawPoland
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