Maciej T Wybraniec1, Aleksander Maciąg2, Dawid Miśkowiec3,4, Beata Ceynowa-Sielawko5, Paweł Balsam3,6, Maciej Wójcik3,7, Wojciech Wróbel8, Michał Farkowski3,2, Edyta Ćwiek-Rębowska4, Marek Szołkiewicz5, Krzysztof Ozierański3,6, Robert Błaszczyk3,7, Karolina Bula8, Tomasz Dembowski4, Michał Peller6, Bartosz Krzowski6, Wojciech Wańha3,9, Marek Koziński3,10, Jarosław D Kasprzak3,4, Hanna Szwed11, Katarzyna Mizia-Stec8,3. 1. First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland, Upper Silesia Medical Center, Katowice, Poland; Club 30” of the Polish Cardiac Society. maciejwybraniec@gmail.com 2. Second Department of Heart Arrhythmia, National Institute of Cardiology, Warsaw, Poland 3. Club 30” of the Polish Cardiac Society 4. Department of Cardiology, Medical University of Lodz, Łódź, Poland 5. Department of Cardiology and Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, Wejherowo, Poland 6. First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland 7. Chair and Department of Cardiology, Medical University of Lublin, Lublin, Poland 8. First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland, Upper Silesia Medical Center, Katowice, Poland 9. Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland, Upper Silesia Medical Center, Katowice, Poland 10. Department of Cardiology and Internal Medicine, Medical University of Gdansk, Gdynia, Poland 11. Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warsaw, Poland
Abstract
INTRODUCTION: Due to safety concerns about available antiarrhythmic drugs (AADs), reliable agents for termination of atrial fibrillation (AF) are requisite. OBJECTIVES: The aim of the study was to evaluate the efficacy and safety of antazoline, a first‑generation antihistamine, for cardioversion of recent‑onset AF in the setting of an emergency department. PATIENTS AND METHODS: This multicenter, retrospective registry covered 1365 patients (median [interquartile range] age, 69.0 [61.0-76.0] years, 53.1% men) with new‑onset AF submitted to urgent pharmacological cardioversion. AAD allocation was performed by the attending physician: antazoline alone was utilized in 600 patients (44%), amiodarone in 287 (21%), propafenone in 150 (11%), and ≥2 AADs in 328 patients (24%). Antazoline in monotherapy or combination was administered to 897 patients (65.7%). Matched antazoline and nonantazoline groups were identified using propensity score matching (PSM, n = 330). The primary end point was return to sinus rhythm within 12 hours after initiation of the treatment. RESULTS: Before PSM, antazoline alone was superior to amiodarone (78.3% vs 66.9%; relative risk [RR], 1.17; 95% CI, 1.07-1.28; P <0.001) and comparable to propafenone (78.3% vs 72.7%; RR, 1.08; 95% CI, 0.97-1.20; P = 0.14) in terms of rhythm conversion rate. In the post‑PSM population, the rhythm conversion rate was higher among patients receiving antazoline alone than in the nonantazoline group (84.2% vs 66.7%; RR, 1.26; 95% CI, 1.11-1.43; P <0.001), and the risk of adverse events was comparable (P = 0.2). CONCLUSIONS: Antazoline appears to be an efficacious agent for termination of AF in real‑world setting. Randomized controlled trials are required to evaluate its safety in specific patient populations.
INTRODUCTION: Due to safety concerns about available antiarrhythmic drugs (AADs), reliable agents for termination of atrial fibrillation (AF) are requisite. OBJECTIVES: The aim of the study was to evaluate the efficacy and safety of antazoline, a first‑generation antihistamine, for cardioversion of recent‑onset AF in the setting of an emergency department. PATIENTS AND METHODS: This multicenter, retrospective registry covered 1365 patients (median [interquartile range] age, 69.0 [61.0-76.0] years, 53.1% men) with new‑onset AF submitted to urgent pharmacological cardioversion. AAD allocation was performed by the attending physician: antazoline alone was utilized in 600 patients (44%), amiodarone in 287 (21%), propafenone in 150 (11%), and ≥2 AADs in 328 patients (24%). Antazoline in monotherapy or combination was administered to 897 patients (65.7%). Matched antazoline and nonantazoline groups were identified using propensity score matching (PSM, n = 330). The primary end point was return to sinus rhythm within 12 hours after initiation of the treatment. RESULTS: Before PSM, antazoline alone was superior to amiodarone (78.3% vs 66.9%; relative risk [RR], 1.17; 95% CI, 1.07-1.28; P <0.001) and comparable to propafenone (78.3% vs 72.7%; RR, 1.08; 95% CI, 0.97-1.20; P = 0.14) in terms of rhythm conversion rate. In the post‑PSM population, the rhythm conversion rate was higher among patients receiving antazoline alone than in the nonantazoline group (84.2% vs 66.7%; RR, 1.26; 95% CI, 1.11-1.43; P <0.001), and the risk of adverse events was comparable (P = 0.2). CONCLUSIONS: Antazoline appears to be an efficacious agent for termination of AF in real‑world setting. Randomized controlled trials are required to evaluate its safety in specific patient populations.
Authors: Beata Ceynowa-Sielawko; Maciej T Wybraniec; Aleksandra Topp-Zielińska; Aleksander Maciąg; Dawid Miśkowiec; Paweł Balsam; Maciej Wójcik; Wojciech Wróbel; Michał M Farkowski; Edyta Ćwiek-Rębowska; Krzysztof Ozierański; Robert Błaszczyk; Karolina Bula; Tomasz Dembowski; Michał Peller; Bartosz Krzowski; Wojciech Wańha; Marek Koziński; Jarosław D Kasprzak; Hanna Szwed; Katarzyna Mizia-Stec; Marek Szołkiewicz Journal: Int J Environ Res Public Health Date: 2022-04-17 Impact factor: 3.390