Efficacy and safety of antazoline in the rapid cardioversion of paroxysmal atrial fibrillation (the AnPAF Study)

Maciąg, Aleksander; Farkowski, Michał M.; Chwyczko, Tomasz; Bęćkowski, Maciej; Syska, Paweł; Kowalik, Ilona; Pytkowski, Mariusz; Wozniak, J; Dąbrowski, Rafał; Szwed, Hanna

doi:10.1093/europace/euw384

Cited by 26 publications

(55 citation statements)

References 18 publications

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“…Other adverse effects observed in the control group were lone cases of dizziness, nausea, chest discomfort or clinical suspicion of CAD, and episodes of atrial flutter/tachycardia after cardioversion. Observed adverse events were concordant with published reports . In the AnPAF trial, mild adverse effects of antazoline (hot flush, metallic taste) affected almost all patients with a single case of unmasking heart failure symptoms resulting in admission and intravenous diuretic …”

Section: Discussionsupporting

confidence: 86%

“…Little is known about the influence of chronic medication on antazoline effectiveness. In the AnPAF randomized trial, the only study with detailed information on chronic treatment, groups were balanced in terms of antiarrhythmic drugs or other medications . Due to high effectiveness and relatively low number of participants in the antazoline arm, the analysis of potential influence of concomitant drugs was abandoned.…”

Section: Discussionmentioning

confidence: 99%

“…Probably, a future registry would be helpful to answer this question. The reported effectiveness of intravenous antazoline varied between studies reaching 72.2% in the randomized controlled trial, 71.6% in unselected series of patients in the emergency department, and even 83.6% in patients undergoing catheter ablation of paroxysmal atrial fibrillation …”

Section: Discussionmentioning

confidence: 99%

“…Clinically, antazoline had been administered intravenously in doses of 50‐100 mg every 3‐5 minutes until CV was successful or up to a cumulative dose of 250‐350 mg with the efficacy as high as 70%‐80% and time to conversion to sinus rhythm ranging between 7 and 20 minutes . Those findings were later confirmed in the randomized controlled trial …”

Section: Introductionmentioning

confidence: 95%

“…In the single randomized trial, 36% (n = 13) patients in the antazoline arm had a documented CAD, but a history of myocardial infarction was considered an exclusion criterion. The study was conducted mostly in the emergency department (ED) . In a recent publication concerning exclusively patients cardioverted in ED, over 40% of patients who were administered antazoline had a documented CAD, including a history of MI …”

Section: Introductionmentioning

confidence: 99%

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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

Farkowski

Maciąg

Zurawska

et al. 2018

Cardiovascular Therapeutics

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Summary 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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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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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

Farkowski

Maciąg

Zurawska

et al. 2018

Cardiovascular Therapeutics

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External electrical and pharmacological cardioversion for atrial fibrillation, atrial flutter or atrial tachycardias: a network meta-analysis

Kukendrarajah,

Ahmad,

Carrington

et al. 2024

Cochrane Database of Systematic Reviews

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The anti-influenza drug oseltamivir reduces atrial fibrillation in an experimental whole-heart model

Frommeyer

Mittelstedt

Wolfes

et al. 2017

Naunyn-Schmiedeberg's Arch Pharmacol

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Recent experimental studies suggested direct effects of the anti-influenza drug oseltamivir on cardiac electrophysiology. We therefore aimed at analyzing potential antiarrhythmic effects of oseltamivir on atrial fibrillation (AF) in an experimental whole-heart model. Twelve rabbit hearts were isolated and Langendorff perfused. Thereafter, hearts were paced at cycle lengths of 350, 250, and 200 ms in the atrium. A standardized protocol employing atrial burst pacing induced AF in 4 of 12 hearts under baseline conditions (33%, 11 episodes). Subsequently, a combination of acetylcholine (1 μM) and isoproterenol (1 μM) was administered to increase AF occurrence. Two monophasic action potential recordings on the left and two on the right atrial epicardium displayed a decrease of atrial action potential duration (aAPD, -38 ms, p < 0.01) and atrial effective refractory period (aERP; -20 ms, p < 0.05). Under the influence of acetylcholine/isoproterenol AF was inducible in 8 of 12 hearts (66%; 69 episodes). Additional infusion of oseltamivir (100 μM) resulted in a significant increase of both aAPD (+ 29 ms, p < 0.05) and aERP (+ 40 ms, p < 0.01) leading to an increase of atrial post-repolarization refractoriness (aPRR). Under the influence of oseltamivir only 3 of 12 hearts (25%, 8 episodes) remained inducible. In six additional hearts oseltamivir (50 μM and 100 μM) did not significantly alter ventricular APD, QRS duration and QT interval but induced a significant increase of ventricular ERP. In the present experimental study, acute infusion of the anti-influenza drug oseltamivir reduced atrial fibrillation. The antiarrhythmic effect can be explained by a significant increase in aERP and aPRR. These results suggest an antiarrhythmic potential of oseltamivir in atrial arrhythmias.

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Efficacy and safety of antazoline in the rapid cardioversion of paroxysmal atrial fibrillation (the AnPAF Study)

Abstract: Intravenous antazoline was effective and safe in the rapid conversion of non-valvular paroxysmal atrial fibrillation to sinus rhythm in patients without heart failure. Clinical Trial Registration number: NCT01527279.

Cited by 26 publications

References 18 publications

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

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

External electrical and pharmacological cardioversion for atrial fibrillation, atrial flutter or atrial tachycardias: a network meta-analysis

The anti-influenza drug oseltamivir reduces atrial fibrillation in an experimental whole-heart model

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