Inappropriate use of antiarrhythmic drugs in paroxysmal and persistent atrial fibrillation in a large contemporary international survey: insights from RealiseAF

Chiang, Chern‐En; Goethals, Marnix; O’Neill, James; Naditch-Brûlé, Lisa; Brette, Sandrine; Gamra, Habib; Zharinov, O.; Steg, Philippe Gabriel

doi:10.1093/europace/eut204

Cited by 16 publications

(11 citation statements)

References 18 publications

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“…The choice of treatment, its dose regimen, and the use of concomitant drugs did not strictly follow the guidelines; however, this was a real‐world data analysis which represented the clinical practice. This is consistent with the previously published data which suggested a high variation in antiarrhythmic drug use with nonguideline treatment frequently used in paroxysmal and persistent AF …”

Section: Discussionsupporting

confidence: 93%

“…A clinically reasonable explanation would be contraindication to other antiarrhythmic drugs or adverse events of such treatment in otherwise stable CAD patients. While disturbing, serious divergence from clinical guidelines in AF pharmacotherapy had been described before . In an American analysis published in 2013, among patients with CAD 16% and 15% of drugs used were propafenone and flecainide, respectively .…”

Section: Discussionmentioning

confidence: 99%

“…In an American analysis published in 2013, among patients with CAD 16% and 15% of drugs used were propafenone and flecainide, respectively . According to an international survey RealiseAF, CAD patients comprised 17.8% class Ic drug users in Europe, 20.8% in Asia, and 10.7% in Africa . Both studies are reflection of real‐life clinical practice and show that insufficient adherence to clinical guidelines is universal across the globe.…”

Section: Discussionmentioning

confidence: 99%

“…While disturbing, serious divergence from clinical guidelines in AF pharmacotherapy had been described before. 17,18 In an American analysis published in 2013, among patients with CAD 16% and 15% of drugs used were propafenone and flecainide, respectively. 17 According to an international survey RealiseAF, CAD patients comprised 17.8% class Ic drug users in Europe, 20.8% in Asia, and 10.7% in Africa.…”

Section: Cad (−) Cad (+) Pmentioning

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: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Cad (−) Cad (+) Pmentioning

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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“…Amiodarone is a type III antiarrhythmic approved for use in ventricular and supraventricular arrhythmias . Amiodarone is the medical treatment of choice for rhythm control of atrial fibrillation in patients with HF with reduced ejection fraction (HFrEF) …”

Section: Introductionmentioning

confidence: 99%

Amiodarone‐induced thyrotoxicosis in heart failure with a reduced ejection fraction: A retrospective cohort study

Yamamoto

Katz

Bras

et al. 2018

Health Science Reports

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BackgroundAmiodarone‐induced thyrotoxicosis (AIT) is associated with significant morbidity and mortality. We aimed to describe AIT and its clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF).MethodsWe performed a retrospective chart review at a heart failure center in Winnipeg, Canada. We screened 1059 consecutive patients seen over a 12‐month period (August 2011 to July 2012) for AIT in patients with HFrEF. Using descriptive and Cox proportional hazard analyses, we explored the association between AIT and mortality.ResultsA total of 110 patients with HFrEF who were exposed to amiodarone were included in the analysis. Of these, 13 (11.8%) were diagnosed with AIT. All AIT patients in our cohort were male. Amiodarone was discontinued in nearly half (46.2%) of patients with AIT. All patients were treated with antithyroid medications, and 5 patients (38.5%) also received prednisone. Euthyroidism was achieved in 2 patients (15.4%), hypothyroidism occurred in 6 patients (46.2%), and 5 patients remained thyrotoxic until death or time of chart review (38.5%).ConclusionThyrotoxicosis is common in patients with HFrEF on amiodarone and is challenging to treat. Due to the sample size, while no association was found in mortality for patients with HFrEF with AIT, a real association could have been missed.

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Treatment of Atrial Fibrillation and Atrial Flutter

Christ

Pecha

Jost

2015

Pathophysiology and Pharmacotherapy of Cardiovascular Disease

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Inappropriate use of antiarrhythmic drugs in paroxysmal and persistent atrial fibrillation in a large contemporary international survey: insights from RealiseAF

Cited by 16 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

Amiodarone‐induced thyrotoxicosis in heart failure with a reduced ejection fraction: A retrospective cohort study

Treatment of Atrial Fibrillation and Atrial Flutter

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