Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter

Platia, Edward V.; Michelson, Eric L.; Porterfield, James K.; Das, Gopal D.

doi:10.1016/0002-9149(89)90141-0

Cited by 189 publications

(82 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Older, small, single-center trials comparing BBs with CCBs among patients with new-onset AF outside the critical care setting have suggested increased rates of conversion to sinus rhythm among patients receiving BBs, without immediate differences in achieving heart rate control. [26][27][28][29] A single-center trial 30 demonstrating improved mortality among patients with septic shock and sinus tachycardia randomized to receive the BB esmolol further supports our finding that BBs may have clinical benefit during sepsis. Although potential mechanisms for beneficial effects of BBs during sepsis are unclear, experimental data support enhanced journal.publications.chestnet.org microvascular, 31 antiinflammatory, 32 and gut mucosal integrity 33 with use of BBs during sepsis.…”

Section: Discussionsupporting

confidence: 67%

Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis

Walkey

Evans

Winter

et al. 2016

Chest

View full text Add to dashboard Cite

BACKGROUND: Atrial fibrillation (AF) during sepsis is associated with increased morbidity and mortality, but practice patterns and outcomes associated with rate-and rhythm-targeted treatments for AF during sepsis are unclear.METHODS: This was a retrospective cohort study using enhanced billing data from approximately 20% of United States hospitals. We identified factors associated with IV AF treatments (b-blockers [BBs], calcium channel blockers [CCBs], digoxin, or amiodarone) during sepsis. We used propensity score matching and instrumental variable approaches to compare mortality between AF treatments.RESULTS: Among 39,693 patients with AF during sepsis, mean age was 77 AE 11 years, 49% were women, and 76% were white. CCBs were the most commonly selected initial AF treatment during sepsis (14,202 patients [36%]), followed by BBs (11,290 [28%]), digoxin (7,937 [20%]), and amiodarone (6,264 [16%]). Initial AF treatment selection differed according to geographic location, hospital teaching status, and physician specialty. In propensity-matched analyses, BBs were associated with lower hospital mortality when compared with CCBs (n ¼ 18,720; relative risk [RR], 0.92; 95% CI, 0.86-0.97), digoxin (n ¼ 13,994; RR, 0.79; 95% CI, 0.75-0.85), and amiodarone (n ¼ 5,378; RR, 0.64; 95% CI, 0.61-0.69). Instrumental variable analysis showed similar results (adjusted RR fifth quintile vs first quintile of hospital BB use rate, 0.67; 95% CI, 0.58-0.79). Results were similar among subgroups with new-onset or preexisting AF, heart failure, vasopressor-dependent shock, or hypertension.CONCLUSIONS: Although CCBs were the most frequently used IV medications for AF during sepsis, BBs were associated with superior clinical outcomes in all subgroups analyzed. Our findings provide rationale for clinical trials comparing the effectiveness of AF rate-and rhythm-targeted treatments during sepsis.

show abstract

Section: Discussionsupporting

confidence: 67%

Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis

Walkey

Evans

Winter

et al. 2016

Chest

View full text Add to dashboard Cite

show abstract

“…The evaluation of drug efficacy by comparing different studies is difficult because of differences in study population characteristics and methodologies including underlying heart disease, duration of arrhythmia, dose and route of drug administration, the monitoring time and, the study endpoints. Pharmacological cardioversion seems to be mostly effective when initiated within first week of the onset of an AF episode (10,11). A large proportion of patients with recent-onset AF experience spontaneous cardioversion within 24 to 48 hours after AF onset (12,13).…”

Section: Discussionmentioning

confidence: 99%

Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs

Balla¹,

Petrela²,

Kondili³

2011

Anadolu Kardiyol Derg

View full text Add to dashboard Cite

ÖZETAmaç: Atriyal fibrilasyonun (AF) sinüs ritmine döndürülmesi çoğu kez emboli riskini ve hemodinamik bozulmanın azaltılması için yapılır. Bu çalışmada, son 48 saat içinde AF geçirmiş hastalar üzerinde tek oral doz flekainid, amiyodaron ve propafenon ile atriyal fibrilasyonun sinüs ritmine dönüşümü üzerindeki etkileri plasebo ile randomize olarak karşılaştırılmıştır. Yöntemler: Bu çalışma 160 hasta üzerinde yapılmış, hastalara rastgele olmak üzere flekainid (3 mg/kg, n=40), amiyodaron (30 mg/kg, n=40), propafenon (8.5 mg/kg, n=40) veya placebo (n=40) verilmiştir. Amaçlanan nokta ilaç alınımı sonrası 24 saat içinde AF'nin sinüs ritmine dönüşüm hızı olmuştur. AF konversiyon oranı ile 3 antiaritmik ilacın kullanımı ile ilişkiler çoklu lojistik regresyon analiz ile değerlendirilmiştir. Bulgular: Amaçlanan etki, flekainid kullanan hastaların %87.5'inde, amiyodaron kullanan hastaların %85'inde, propafenon kullanan hastaların 85%'inde, plasebo kullanan hastaların ise %17.5'inde (p<0.001 her 3 ilacın plasebo ile karşılaştırılması) gerçekleşmiştir. İlaç alımından 3 saat sonraki dönüşüm hızı, amiodaron (%0) ve plasebo (%10) ile karşılaştırıldığında; Propafenon grubunda (%57.5) ve flekainid grubunda (%45) olmak üzere daha yüksek bulunmuştur. Amiyodaron kullanan hastalar 6 ve 24 saat içinde, flekainid veya propafenon grubu hastalara göre anlamlı olarak daha fazla sinüs ritmine döndürülmüştür. Plasebo ile kıyaslandığında antiaritmik ilaçların kullanımı sinüs ritmine dönüştürmede belirgin derecede üstün bulundu (düzeltilmiş OR=19.53, %95 GA 3.14-121.55, p<0.001). Önemli yan etki gözlenmedi. Sonuç: Atriyal fibrilasyona yakın zamanda girmiş hastalarda oral ilaç alımını izleyen 24 saatlik süreç içinde sinüs ritmine geri döndürmede flekainid, amiyodaron veya propafenon grubu, plasebo grubuna göre üstün bulunmuştur. Propafenon ve flekainid'in oral alım sonrası ilk 3 saat içinde amiyodaron'a göre daha etkili olmakla birlikte her 3 antiaritmik ilaç benzer etkinliktedir. (Anadolu Kardiyol Derg 2011; 11: 600-6) Anahtar kelimeler: Amiyodaron, atriyal fibrilasyon, flekainid, propafenon, sinüs ritm, lojistik regresyon analizi ABSTRACT Objective: In this study, we randomly compared single oral doses of flecainide, amiodarone and propafenone versus placebo for the conversion of recent atrial fibrillation (AF) (within 48 hours). Methods: This is a randomized prospective, placebo-controlled single-blind study that included 160 consecutive patients with recent AF who were randomly assigned to single oral doses of flecainide (3 mg/kg of weight, n=40), amiodarone (30 mg/kg weight, n=40), propafenone (8.5 mg/ kg of weight, n=40) or placebo (n=40). The primary end-point was conversion rate at 24 hours after the drug intake. The association between antiarrhythmic use and conversion rate was tested with multiple logistic regressions. Results: The primary end-point was achieved in 87.5% of patients with flecainide, 85% of patients with amiodarone, 85% of patients with propafenone and 17.5% of patients with placebo (p<0.001 compared with placebo for...

show abstract

“…In hemodynamically unstable patients, electrical cardioversion is indicated. [61][62][63][64] (Class I, Level of Evidence: B)…”

Section: The Measures and Specifications Are Provided "As Is" Withoutmentioning

confidence: 99%

2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter

Heidenreich¹,

Solis²,

Estes³

et al. 2016

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

The American Heart Association requests that this document be cited as follows: Heidenreich PA, Solis P, Estes NAM 3rd, Fonarow GC, Jurgens CY, Marine JE, McManus DD, McNamara RL. 2016 ACC/AHA clinical performance and quality measures for adults with atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes. 2016;9:443-488. DOI: 10.1161/HCQ.0000000000000018. This article has been copublished in the Journal of the American College of Cardiology.Copies: This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org) and the American Heart Association (professional.heart.org). A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://professional.heart.org/statements. Select the "Guidelines & Statements" drop-down menu, then click "Publication Development."Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/CopyrightPermission-Guidelines_UCM_300404_Article.jsp. A link to the "Copyright Permissions Request Form" appears on the right side of the page. PreambleThe American College of Cardiology (ACC)/American Heart Association (AHA) clinical performance and quality measure sets serve as vehicles to accelerate translation of scientific evidence into clinical practice. Measure sets developed by the ACC/AHA are intended to provide practitioners and institutions that deliver cardiovascular services with tools to measure the quality of care provided and identify opportunities for improvement. Writing committees are instructed to consider the methodology of clinical performance measure development 1 and to ensure that the measures developed are aligned with ACC/AHA clinical guidelines. The writing committees also are charged with constructing measures that maximally capture important aspects of care quality, including timeliness, safety, effectiveness, efficiency, equity, and patient-centeredness, while minimizing, when possible, the reporting burden imposed on hospitals, practices, and practitioners. Potential challenges from measure implementation may lead to unintended consequences. The manner in which challenges are addressed is dependent on several factors, including the measure design, data collection method, performance attribution, baseline performance rates, reporting methods, and incentives linked to these reports.The ACC/AHA Task Force on Performance Measures d...

show abstract

Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter

Cited by 189 publications

References 18 publications

Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis

Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis

Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs

2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter

Contact Info

Product

Resources

About