Newer antiarrhythmic agents for maintaining sinus rhythm in atrial fibrillation: simplicity or complexity?

Singh, Bramah N.; Aliot, Étienne

doi:10.1093/eurheartj/sum049

Cited by 13 publications

(12 citation statements)

References 49 publications

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“…In addition, those changes may be responsible for the loss of efficacy of antiarrhythmic drugs in treating patients with AF over the long term. [11,12] Two phenomena are involved in the origin and maintenance of the arrhythmia: the abnormal automaticity inside the pulmonary veins, and the shortening of the refractory period of atrial cells favoring re-entry. This effect of shortening of the atrial refractory period was described in Allessie's laboratory, together with the loss of the normal relationship between cycle length and refractory period.…”

Section: Atrial Remodeling and Changes In Persistent Afmentioning

confidence: 99%

Non-Antiarrhythmic Drugs to Prevent Atrial Fibrillation

Moro

Hernández‐Madrid

Matía

2010

American Journal Cardiovascular Drugs

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Atrial fibrillation (AF) is the most frequent arrhythmia found in clinical practice. The majority of patients with AF are still candidates for antiarrhythmic drug treatment, not only for acute reversion to sinus rhythm but also for long-term treatment to prevent recurrences of AF. Currently available antiarrhythmic drugs, however, are unable to provide complete efficacy in all patients, and present problematic risks of proarrhythmia. The progressively increasing prevalence of AF supports the need to develop improved therapeutic approaches for the clinical management of arrhythmia. Accordingly, new treatment techniques aimed at suppressing the origin of the arrhythmogenic foci have been developed in the last decade. However, ablative treatments are only available for selected patients. Because of these factors, and also because primary prevention of AF should be our goal, the introduction of non-antiarrhythmic agents that could prevent both new-onset AF and recurrences of AF may eventually improve patient outcomes and reduce the incidence of this epidemic disease. The potential clinical value of these non-antiarrhythmic options is currently under active investigation. There is now clinical and experimental evidence that many drugs may have beneficial effects in preventing AF through several possible mechanisms. Non-antiarrhythmic drugs, such as ACE inhibitors and angiotensin receptor blockers, HMG-CoA reductase inhibitors (statins), corticosteroids, and N-3 polyunsaturated fatty acids may have a positive effect in patients with AF or in preventing AF in patients at risk.

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Section: Atrial Remodeling and Changes In Persistent Afmentioning

confidence: 99%

Non-Antiarrhythmic Drugs to Prevent Atrial Fibrillation

Moro

Hernández‐Madrid

Matía

2010

American Journal Cardiovascular Drugs

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“…Study visits in the outpatient clinic were scheduled on days 10,17,28,56, and 90 after random assignment. A final follow-up telephone call was performed 30 days after the last dose of study drug for all patients.…”

Section: Clinical Perspective On P 643mentioning

confidence: 99%

“…17 Of the various class I and III antiarrhythmics that have been studied in controlled trials for the maintenance of sinus rhythm, 15 amiodarone has shown the highest rate of efficacy. 16 However, amiodarone has numerous side effects and has reported discontinuation rates due to side effects in up to 23% of patients over the course of 1 to 2 years.…”

Section: Other Antiarrhythmicsmentioning

confidence: 99%

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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“…B.N. Singh (США) и E. Aliot (Франция) в 2007 г. опубликовали в European Heart Journal статью [26], в которой констатировали необходимость поиска новых путей увеличения эффективности и безопасности медикаментозного лечения ФП. По их мнению, для достижения этой цели надо использовать следующие подходы:…”

Section: выбор препарата для профилактической антиаритмической терапиunclassified

Current Principles and Trends of Atrial Fibrillation Pharmacotherapy

Bunin¹

2009

Racionalʹnaâ farmakoterapiâ v kardiologii

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Современные подходы и перспективы фармакотерапии фибрилляции предсердий Ю.А. Бунин* Российская медицинская академия последипломного образования, 123995 Москва, Баррикадная ул., 2/1 Представлены данные об эпидемиологии фибрилляция предсердий (ФП) и ее влиянии на риск сердечно-сосудистых осложнений. Изложены общие принципы и тактика лечения больных с ФП с позиций доказательной медицины согласно последним рекомендациям Европейского общества кардиологов. Описаны алгоритмы выбора оптимальной тактики лечения (на основании стратификации риска) антиаритмическими препаратами основных классов и антикоагулянтами. Обозначены перспективные направления в повышении эффективности и безопасности лечения ФП.

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Newer antiarrhythmic agents for maintaining sinus rhythm in atrial fibrillation: simplicity or complexity?

Cited by 13 publications

References 49 publications

Non-Antiarrhythmic Drugs to Prevent Atrial Fibrillation

Non-Antiarrhythmic Drugs to Prevent Atrial Fibrillation

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

Current Principles and Trends of Atrial Fibrillation Pharmacotherapy

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