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)

Farkowski, Michał M.; Maciąg, Aleksander; Kowalik, Ilona; Konka, Marek; Szwed, Hanna; Pytkowski, Mariusz

doi:10.1111/bcp.13940

Cited by 9 publications

(10 citation statements)

References 24 publications

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“…It is noteworthy that our search retrieved a total of 6 articles (in 1612 patients) that included PCV using antazoline mesilate. 19,[32][33][34]42,66 This is an old antihistaminic drug, which, despite its proven antiarrhythmic efficacy, is not currently mentioned in any AF guidelines. [72][73][74] According to publicly available data, it appears that the intravenous form of antazoline is registered and sold in Poland only; therefore, it is not surprising that majority of the research on antazoline was conducted and published by Polish physicians.…”

Section: Resultsmentioning

confidence: 99%

Does the choice of drug in pharmacologic cardioversion correlate with the guidelines? Systematic review

Springer¹,

Szmuda²,

Kozłowski³

2021

Adv Clin Exp Med

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Background. Atrial fibrillation (AF) is the most common sustained arrhythmia, the most common cause of supraventricular tachycardia in the global population and the most common arrhythmia requiring treatment in an emergency department. Objectives.To systematically review recent literature and quantify the correlation between the choice of pharmacological cardioversion (PCV) drug and the national or international guidelines. Materials and methods.A systematic review was performed in accordance with the PRISMA statement methodology. The PubMed search engine was used to search for articles regardless of type or language and published in the last 6 years (May 2014-May 2020). In addition, we searched for AF guidelines and recommendations published online by cardiology and emergency medicine societies.Results. The search strategy returned a total of 2615 abstracts. A total of 2598 full texts were screened; 2540 full texts were excluded with reasons and 58 articles from 32 countries were included in the analysis. In 17 of the 58 articles (29%), we noted discrepancies with the AF guidelines, specifically regarding the PCV drug used, the patients' comorbidities and the contraindications associated with the PCV drug. The most common clinical situation for the use of a contraindicated drug was when ibutilide was administered to patients with heart failure. The analysis did not reveal any statistically significant correlations, although the correlation between the sample size and guideline adherence was close to statistical significance (p < 0.06). Conclusions.Our systematic analysis revealed substantial non-adherence to AF treatment guidelines.

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Section: Resultsmentioning

confidence: 99%

Does the choice of drug in pharmacologic cardioversion correlate with the guidelines? Systematic review

Springer¹,

Szmuda²,

Kozłowski³

2021

Adv Clin Exp Med

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“…Antazoline is an anti-histaminic drug that has also been repurposed for AF management due to its multi-ionic effects and has shown effectiveness in AF cardioversion during PVI [ 151 , 152 ]. In addition, a small RCT of 74 paroxysmal AF subjects (AnPAF study) demonstrated that intravenous antazoline is effective in rapid cardioversion of AF [ 153 ].…”

Section: Therapeutic Perspectivesmentioning

confidence: 99%

Molecular Insights in Atrial Fibrillation Pathogenesis and Therapeutics: A Narrative Review

et al. 2021

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The prevalence of atrial fibrillation (AF) is bound to increase globally in the following years, affecting the quality of life of millions of people, increasing mortality and morbidity, and beleaguering health care systems. Increasingly effective therapeutic options against AF are the constantly evolving electroanatomic substrate mapping systems of the left atrium (LA) and ablation catheter technologies. Yet, a prerequisite for better long-term success rates is the understanding of AF pathogenesis and maintenance. LA electrical and anatomical remodeling remains in the epicenter of current research for novel diagnostic and treatment modalities. On a molecular level, electrical remodeling lies on impaired calcium handling, enhanced inwardly rectifying potassium currents, and gap junction perturbations. In addition, a wide array of profibrotic stimuli activates fibroblast to an increased extracellular matrix turnover via various intermediaries. Concomitant dysregulation of the autonomic nervous system and the humoral function of increased epicardial adipose tissue (EAT) are established mediators in the pathophysiology of AF. Local atrial lymphomononuclear cells infiltrate and increased inflammasome activity accelerate and perpetuate arrhythmia substrate. Finally, impaired intracellular protein metabolism, excessive oxidative stress, and mitochondrial dysfunction deplete atrial cardiomyocyte ATP and promote arrhythmogenesis. These overlapping cellular and molecular alterations hinder us from distinguishing the cause from the effect in AF pathogenesis. Yet, a plethora of therapeutic modalities target these molecular perturbations and hold promise in combating the AF burden. Namely, atrial selective ion channel inhibitors, AF gene therapy, anti-fibrotic agents, AF drug repurposing, immunomodulators, and indirect cardiac neuromodulation are discussed here.

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“…Cryoablation is primarily used to treat paroxysmal AF when the sources of the arrhythmia are focally located in the pulmonary vein region of the left atrium (LA) [ 7 ]; however, it is also proven to be safe and effective treatment of persistent AF, which is accompanied by complex underlying mechanisms such as progressive electrical, structural remodeling and fibrosis of the atrial myocardium [ 8 ]. The pulmonary vein isolation (PVI) procedure may induce AF, and hence affect its assessment; therefore it generally requires subsequent electrical or pharmacological cardioversion [ 9 ]. Transthoracic synchronized CVE is well known as the treatment of choice in immediate termination of AF and restoring sinus rhythm among hemodynamically unstable patients and it is more effective than pharmacological cardioversion despite the requirement of sedation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of efficacy of pharmacological cardioversion with antazoline and propafenone versus electrical cardioversion in atrial fibrillation during cryoablation

Klocek,

Tworek,

Klimek

et al. 2024

pwki

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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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Cited by 9 publications

References 24 publications

Does the choice of drug in pharmacologic cardioversion correlate with the guidelines? Systematic review

Does the choice of drug in pharmacologic cardioversion correlate with the guidelines? Systematic review

Molecular Insights in Atrial Fibrillation Pathogenesis and Therapeutics: A Narrative Review

Comparison of efficacy of pharmacological cardioversion with antazoline and propafenone versus electrical cardioversion in atrial fibrillation during cryoablation

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