Atrial fibrillation: Choosing an antiarrhythmic drug

Rudo, Todd; Kowey, Peter R.

doi:10.1007/s11886-006-0077-z

Cited by 8 publications

(2 citation statements)

References 47 publications

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“…2,3 Class 1C antiarrhythmics and sotalol are associated with risks of proarrhythmia, which limit their use. 4 Finally, the newly registered dronedarone was significantly inferior to amiodarone for the composite primary end point of time to first AF recurrence or premature study drug discontinuation (due to intolerance or lack of efficacy). 5 Thus, there is a continued need to develop safe and efficacious antiarrhythmic drugs.…”

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confidence: 93%

A Randomized, Placebo-Controlled Study of Vernakalant (Oral) for the Prevention of Atrial Fibrillation Recurrence After Cardioversion

Torp‐Pedersen

Raev

Dickinson

et al. 2011

Circ: Arrhythmia and Electrophysiology

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Background-Vernakalant, a relatively atrial-selective antiarrhythmic drug, has previously demonstrated efficacy for the acute conversion of atrial fibrillation (AF) to sinus rhythm. This study was designed to determine the most appropriate oral dose of vernakalant for the prevention of AF recurrence postcardioversion. Methods and Results-Patients with nonpermanent AF were randomized to 150, 300, or 500 mg vernakalant or placebo twice daily for up to 90 days. The efficacy analysis was conducted on 605 of 735 patients who entered the maintenance phase on day 3 after cardioversion. The time to the first recurrence of symptomatic sustained AF was significantly longer in the 500 mg vernakalant group, with a median of Ͼ90 days versus 29 days in the placebo group (hazard ratio, 0.735; Pϭ0.0275). No significant effect was seen at the lower doses. The percent of patients in sinus rhythm at day 90 was 41%, 39%, and 49% in the 150-mg (nϭ147), 300-mg (nϭ148), and 500-mg (nϭ150) vernakalant groups, respectively, compared with 36% in the placebo group (nϭ160). There were no vernakalant-related proarrhythmic events. Related serious adverse events occurred in 2 patients in the 150-mg vernakalant group and in 1 patient in each of the other groups. Conclusions-Vernakalant, 500 mg twice daily, appears to be effective and safe for the prevention of AF recurrence after cardioversion. The absence of proarrhythmia and favorable safety profile is an important finding for the drug. Key Words: antiarrhythmia agents Ⅲ arrhythmia Ⅲ cardioversion Ⅲ prevention Ⅲ vernakalant M aintenance of sinus rhythm is a necessary goal in many patients with paroxysmal or persistent atrial fibrillation (AF). In the Euro Heart Survey, 1 77% of patients with paroxysmal or persistent AF received pharmaceutical rhythm control therapy. Currently available antiarrhythmic drugs have important limitations. The most effective compound, amiodarone, is associated with severe noncardiac side effects. 2,3 Class 1C antiarrhythmics and sotalol are associated with risks of proarrhythmia, which limit their use. 4 Finally, the newly registered dronedarone was significantly inferior to amiodarone for the composite primary end point of time to first AF recurrence or premature study drug discontinuation (due to intolerance or lack of efficacy). 5 Thus, there is a continued need to develop safe and efficacious antiarrhythmic drugs. Clinical Perspective on p 643Vernakalant represents a novel class of antiarrhythmics being developed for conversion as well as maintenance of sinus rhythm after conversion. The electrophysiological properties differ from currently available compounds. Vernakalant has relative atrial specificity and targets early-activating and acetylcholine-activated potassium channels and has a weak effect on sodium channels in atria and ventricles. 6 -8 Vernakalant slows conduction at rapid pacing rates and prolongs atrial refractoriness. The intravenous formulation has been demonstrated to rapidly convert recent onset AF to sinus rhythm in several clinical trials...

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confidence: 93%

A Randomized, Placebo-Controlled Study of Vernakalant (Oral) for the Prevention of Atrial Fibrillation Recurrence After Cardioversion

Torp‐Pedersen

Raev

Dickinson

et al. 2011

Circ: Arrhythmia and Electrophysiology

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“…Actualmente, los fá rmacos antiarrítmicos se utilizan con el fin de controlar la frecuencia ventricular, restablecer el ritmo sinusal y/o prevenir las recurrencias 8 , pero tienen una elevada tasa de efectos adversos (EA) [9][10][11][12][13][14] . Este hecho representa una de las mayores dificultades que encuentran los mé dicos que atienden a pacientes con FA a la hora de determinar el tratamiento antiarrítmico má s apropiado 15 . La toxicidad de los antiarrítmicos puede deberse a efectos proarrítmicos o a efectos no arritmogé -nicos.…”

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Estudio sobre los efectos adversos de los fármacos antiarrítmicos en pacientes con fibrilación auricular atendidos en un Centro de Atención Primaria

et al. 2011

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Pathophysiological and therapeutic implications in patients with atrial fibrillation and heart failure

et al. 2017

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Heart failure and atrial fibrillation are common and responsible for significant mortality of patients. Both share the same risk factors like hypertension, ischemic heart disease, diabetes, obesity, arteriosclerosis, and age. A variety of microscopic and macroscopic changes favor the genesis of atrial fibrillation in patients with preexisting heart failure, altered subcellular Ca homeostasis leading to increased cellular automaticity as well as concomitant fibrosis that are induced by pressure/volume overload and altered neurohumoral states. Atrial fibrillation itself promotes clinical deterioration of patients with preexisting heart failure as atrial contraction significantly contributes to ventricular filling. In addition, atrial fibrillation induced tachycardia can even further compromise ventricular function by inducing tachycardiomyopathy. Even though evidence has been provided that atrial functions significantly and independently of confounding ventricular pathologies, correlate with mortality of heart failure patients, rate and rhythm controls have been shown to be of equal effectiveness in improving mortality. Yet, it also has been shown that cohorts of patients with heart failure benefit from a rhythm control concept regarding symptom control and hospitalization. To date, amiodarone is the most feasible approach to restore sinus rhythm, yet its use is limited by its extensive side-effect profile. In addition, other therapies like catheter-based pulmonary vein isolation are of increasing importance. A wide range of heart failure-specific therapies are available with mixed impact on new onset or perpetuation of atrial fibrillation. This review highlights pathophysiological concepts and possible therapeutic approaches to treat patients with heart failure at risk for or with atrial fibrillation.

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Atrial fibrillation: Choosing an antiarrhythmic drug

Cited by 8 publications

References 47 publications

A Randomized, Placebo-Controlled Study of Vernakalant (Oral) for the Prevention of Atrial Fibrillation Recurrence After Cardioversion

A Randomized, Placebo-Controlled Study of Vernakalant (Oral) for the Prevention of Atrial Fibrillation Recurrence After Cardioversion

Estudio sobre los efectos adversos de los fármacos antiarrítmicos en pacientes con fibrilación auricular atendidos en un Centro de Atención Primaria

Pathophysiological and therapeutic implications in patients with atrial fibrillation and heart failure

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