AIMS: A recently published trial has shown no differences in outcomes between patients with new-onset supraventricular arrhythmia (SVA) in septic shock treated with either propafenone or amiodarone. However, these outcome data have not been evaluated in relation to the presence or absence of a dilated left atrium (LA). METHODS AND RESULTS: Patients with SVA and a left ventricular ejection fraction ≥ 35% were randomized to receive intravenous propafenone (70 mg bolus followed by 400-840 mg/24 h) or amiodarone (300 mg bolus followed by 600-1800 mg/24 h). They were divided into groups based on whether their end-systolic left atrial volume (LAVI) was ≥40 mL/m2. The subgroup outcomes assessed were survival at ICU discharge, 1 month, 3 months, 6 months, and 12 months. Propafenone cardioverted earlier (P = 0.009) and with fewer recurrences (P = 0.001) in the patients without LA enlargement (n = 133). Patients with LAVI < 40 mL/m2 demonstrated a mortality benefit of propafenone over the follow-up of 1 year [Cox regression, hazard ratio (HR) 0.6 (95% CI 0.4; 0.9), P = 0.014]. Patients with dilated LA (n = 37) achieved rhythm control earlier in amiodarone (P = 0.05) with similar rates of recurrences (P = 0.5) compared to propafenone. The outcomes for patients with LAVI ≥ 40 mL/m2 were less favourable with propafenone compared to amiodarone at 1 month [HR 3.6 (95% CI 1.03; 12.5), P = 0.045]; however, it did not reach statistical significance at 1 year [HR 1.9 (95% CI 0.8; 4.4), P = 0.138]. CONCLUSION: Patients with non-dilated LA who achieved rhythm control with propafenone in the setting of septic shock had better short-term and long-term outcomes than those treated with amiodarone, which seemed to be more effective in patients with LAVI ≥ 40 mL/m2. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03029169, registered on 24 January 2017.
- MeSH
- Amiodarone * therapeutic use administration & dosage MeSH
- Anti-Arrhythmia Agents * therapeutic use administration & dosage MeSH
- Middle Aged MeSH
- Humans MeSH
- Propafenone * therapeutic use administration & dosage MeSH
- Aged MeSH
- Shock, Septic * drug therapy physiopathology MeSH
- Heart Atria * physiopathology diagnostic imaging drug effects MeSH
- Tachycardia, Supraventricular * drug therapy physiopathology MeSH
- Stroke Volume physiology drug effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
PURPOSE: The echocardiography parameters may predict the maintenance of sinus rhythm after cardioversion of a supraventricular arrhythmia (SVA). MATERIALS AND METHODS: Patients in septic shock with onset of an SVA, normal to moderately reduced LV systolic function (EF_LV˃̳35%) and on a continuous noradrenaline of <1.0 μg/kg.min were included. Echocardiography was performed at the arrhythmia onset, 1 h and 4 h post cardioversion on an infusion of propafenone or amiodarone. RESULTS: Cardioversion was achieved in 96% of the 209 patients within a median time of 6(1.8-15.6)h, 134(64.1%) patients experienced at least one SVA recurrence after cardioversion. At 4 h the left atrial emptying fraction (LA_EF, cut-off 38.4%, AUC 0.69,p˂0.001), and transmitral A wave velocity-time-integral (Avti, cut-off 6.8 cm, AUC 0.65,p = 0.001) showed as limited predictors of a single arrhythmia recurrence. The LA_EF 44(36,49)%, (p = 0.005) and the Avti 8.65(7.13,9.50)cm, (p < 0.001) were associated with sustained sinus rhythm and decreased proportionally to increasing numbers of arrhythmia recurrences (p < 0.001 and p = 0.007, respectively). The enlarged left atrial end-systolic diameter at the arrhythmia onset (p = 0.04) and elevated systolic pulmonary artery pressure at 4 h (p = 0.007) were weak predictors of multiple(˃3) recurrences. CONCLUSION: The LA_EF and Avti are related to arrhythmia recurrences post-cardioversion suggesting potential guidance to the choice between rhythm and rate control strategies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03029169, registered on 24th of January 2017.
- MeSH
- Amiodarone therapeutic use administration & dosage MeSH
- Anti-Arrhythmia Agents therapeutic use MeSH
- Echocardiography * MeSH
- Electric Countershock * MeSH
- Middle Aged MeSH
- Humans MeSH
- Propafenone therapeutic use administration & dosage MeSH
- Prospective Studies MeSH
- Recurrence MeSH
- Aged MeSH
- Shock, Septic * therapy physiopathology complications MeSH
- Tachycardia, Supraventricular therapy physiopathology diagnostic imaging MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Anti-Arrhythmia Agents administration & dosage MeSH
- Echocardiography MeSH
- Atrial Fibrillation * diagnostic imaging drug therapy complications physiopathology therapy MeSH
- Clinical Decision-Making MeSH
- Middle Aged MeSH
- Humans MeSH
- Metoprolol administration & dosage MeSH
- Natriuretic Peptides * analysis MeSH
- Propafenone administration & dosage MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Fibrilace síní je jednou z nejčastěji se vyskytujících tachyarytmií. I přes pokroky v léčbě v posledních desetiletích nadále zůstává jedním z hlavních důvodů kardiovaskulární morbidity a mortality. Kromě antikoagulační terapie jako prevence tromboembolických komplikací je cílem naší léčby buď kontrola frekvence komor, nebo kontrola srdečního rytmu. Dle doposud publikovaných prací nebyla do této doby prokázána superiorita kontroly rytmu, a proto v doporučených postupech Evropské kardiologické společnosti z roku 2020 byla indikací ke strategii kontroly rytmu přítomnost symptomů či snaha o zlepšení kvality života. Recentní multicentrická randomizovaná studie EAST‐AFNET 4 však jako první prokázala nižší morbiditu a mortalitu u pacientů s nově diagnostikovanou fibrilací síní a přidruženými kardiovaskulárními rizikovými faktory časně léčených strategií kontroly rytmu (farmakologicky, elektrickou kardioverzí či ablací) ve srovnání s pacienty léčenými standardním režimem. Tato kazuistika prezentuje případ pacienta, u něhož byla zvolena časná strategie kontroly rytmu, obdobně jako u pacientů ve výše uvedené studii.
Atrial fibrillation is one of the most common tachyarrhythmias. Despite advances in treatment in recent decades, atrial fibrillation remains one of the major causes of cardiovascular morbidity and mortality. In addition to anticoagulant therapy to prevent thromboembolic complications, the goal of our treatment is to either control ventricular rate or control heart rhythm. According to previously published trials, the superiority of rhythm control has not been proved so far, thus in the guidelines of the European Society of Cardiology published in 2020, the indication for the rhythm control strategy was the presence of symptoms and the effort to improve the quality of life. Recently published multicenter randomized trial EAST‐AFNET 4 showed that the strategy of initiating rhythm‐control therapy (pharmacologically, electrical cardioversion, or ablation) in patients with early atrial fibrillation and concomitant cardiovascular conditions was associated with a lower cardiovascular morbidity and mortality. This case report presents a patient treated with an early rhythm control strategy similar to the management of patients in EAST‐AFNET 4 trial.
- MeSH
- Anti-Arrhythmia Agents administration & dosage therapeutic use MeSH
- Anticoagulants therapeutic use MeSH
- Atrial Fibrillation * diagnosis drug therapy therapy MeSH
- Humans MeSH
- Metoprolol administration & dosage therapeutic use MeSH
- Propafenone * administration & dosage therapeutic use MeSH
- Radiofrequency Ablation MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
A novel sensor based on a modification of glassy carbon electrode (GCE) with NH2-functionalized multi-walled carbon nano-tubes (NH2fMWCNTs) is reported and its applicability to the electrochemical sensing of Propafenone (PPF) demonstrated. The electrochemical catalytic activity was also utilized as a sensitive detection method for the investigation of the detailed redox mechanism of PFF using cyclic and and differential pulse voltammetry. The surface morphology of the sensor was investigated by SEM armed with EDX probe. Electrochemical impedance spectroscopy was employed as well to define the electron transfer capability of modified and bare electrodes. Key experimental and instrumental conditions related to electrochemical determination by cyclic, differential pulse, and square wave voltammetry, such as amount of modifier, pH, scan rate, accumulation time and potential were studied and optimized. The results have shown a significant enhancement of the peak current after modifying the electrode; the calibration curves of PPF offering good linearity from 0.1 to 10 μM, limit of quantification (LOQ) being 0.03 μM and limit of detection (LOD) 0.01 μM, both when using DPV technique. The proposed sensor was successfully applied to the determination of PFF in dosage form without any special purification, separation or pre-treatment steps. The results of analyses obtained with the proposed sensor were satisfactory and fully statistically relevant.
- MeSH
- Anti-Arrhythmia Agents MeSH
- Electrodes MeSH
- Technology, Pharmaceutical instrumentation methods MeSH
- Dielectric Spectroscopy MeSH
- Calibration MeSH
- Hydrogen-Ion Concentration MeSH
- Oxygen chemistry MeSH
- Dosage Forms * MeSH
- Limit of Detection MeSH
- Microscopy, Electron, Scanning MeSH
- Nanomedicine MeSH
- Nanotubes, Carbon chemistry MeSH
- Propafenone administration & dosage MeSH
- Carbon chemistry MeSH
- Publication type
- Journal Article MeSH
- Keywords
- biologický poločas, esmolol, magnesium sulfuricum, vernakalant,
- MeSH
- Acetanilides administration & dosage pharmacology adverse effects MeSH
- Adenosine administration & dosage pharmacology adverse effects MeSH
- Amiodarone administration & dosage pharmacokinetics pharmacology adverse effects MeSH
- Anti-Arrhythmia Agents * administration & dosage pharmacokinetics pharmacology classification metabolism adverse effects MeSH
- Atropine administration & dosage pharmacokinetics pharmacology adverse effects MeSH
- Adrenergic beta-Antagonists administration & dosage pharmacokinetics pharmacology classification adverse effects MeSH
- Potassium Channel Blockers administration & dosage pharmacokinetics pharmacology classification adverse effects MeSH
- Calcium Channel Blockers administration & dosage pharmacokinetics pharmacology adverse effects MeSH
- Sodium Channel Blockers administration & dosage pharmacokinetics pharmacology classification adverse effects MeSH
- Dronedarone administration & dosage pharmacokinetics pharmacology adverse effects MeSH
- Phenytoin administration & dosage pharmacokinetics pharmacology adverse effects MeSH
- Cardiovascular Diseases * drug therapy MeSH
- Drug Interactions MeSH
- Humans MeSH
- Metoprolol administration & dosage pharmacokinetics pharmacology adverse effects MeSH
- Liver Diseases complications MeSH
- Kidney Diseases complications MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Prajmaline administration & dosage pharmacokinetics pharmacology adverse effects MeSH
- Propafenone administration & dosage pharmacokinetics pharmacology adverse effects MeSH
- Sotalol administration & dosage pharmacokinetics pharmacology adverse effects MeSH
- Verapamil administration & dosage pharmacokinetics pharmacology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Anti-Arrhythmia Agents * therapeutic use MeSH
- Electrocardiography methods MeSH
- Atrial Flutter diagnosis drug therapy physiopathology MeSH
- Humans MeSH
- Infant, Newborn, Diseases MeSH
- Fetal Diseases diagnosis etiology physiopathology MeSH
- Infant, Newborn MeSH
- Fetus MeSH
- Prenatal Diagnosis MeSH
- Propafenone administration & dosage MeSH
- Sotalol administration & dosage MeSH
- Heart Rate, Fetal MeSH
- Heart Rate * drug effects MeSH
- Tachycardia, Supraventricular * diagnosis etiology drug therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Publication type
- Case Reports MeSH
Článek pojednává o indikacích a kontraindikacích jednotlivých dostupných antiarytmik v léčbě fibrilace síní. Jsou probrány možnosti farmakoterapie v akutním i dlouhodobém managementu pacientů, možnosti v rámci strategií kontroly adekvátní komorové odpovědi i snahy o udržení sinusového rytmu.
The article deals with the indications and counterindications of individual accessible antiarythmia in the treatment of atrial fibrillation. It discusses the options for pharmacotherapy in the acute and long-term management of patients, options for a control strategy for an adequate ventricular response and efforts to maintain sinus rhythm.
- Keywords
- kontrola rytmu, rate-control,
- MeSH
- Amiodarone administration & dosage adverse effects therapeutic use MeSH
- Anisoles therapeutic use MeSH
- Anti-Arrhythmia Agents administration & dosage adverse effects therapeutic use MeSH
- Adrenergic beta-Antagonists therapeutic use MeSH
- Long-Term Care utilization MeSH
- Electric Countershock methods utilization MeSH
- Atrial Fibrillation drug therapy therapy MeSH
- Cardiology methods trends MeSH
- Comorbidity MeSH
- Humans MeSH
- Medication Therapy Management MeSH
- Propafenone administration & dosage adverse effects therapeutic use MeSH
- Pyrrolidines therapeutic use MeSH
- Practice Guidelines as Topic standards MeSH
- Heart Rate physiology drug effects MeSH
- Check Tag
- Humans MeSH
V současné době používaná i zkoumaná antiarytmika mají dobrý antiarytmický efekt, ale nemají signifikantní vliv na snížení mortality a všechna mají určitý proarytmický efekt. U supraventrikulárních tachykardií s reentry mechanizmem a u komorových tachykardií v nepřítomnosti strukturálního srdečního onemocnění se v posledních letech staly léčebnou metodou 1. volby katetrizační ablace a antiarytmická farmakoterapie je v těchto případech až metodou 2. volby. U komplexních forem supraventrikulárních i komorových tachyarytmií zůstává antiarytmická farmakoterapie metodou 1. volby a nezastupitelné místo bude mít při hybridní léčbě v kombinaci s katetrizačními ablacemi či s implantabilními kardiovertery-defibrilátory. Je provedeno zhodnocení vztahu a porovnání výsledků studií s farmakoterapií i s nefarmakologickou léčbou. Je podán popis mechanizmů účinků antiarytmik a charakteristika vlastností a účinků jednotlivých antiarytmik třídy IC a III. Klíčová slova: antiarytmika třídy IC a III.
There is evidence of good antiarrhythmic effect of available drugs for arrhythmia treatment but these drugs have no significant effect on mortality and all of them have some proarrhythmic effect. Radiofrequency ablation became the treatment method of the 1st. choice in patients with supraventricular tachyarrhythmias of reentry mechanism and in patients with ventricular tachyarrhythmias without structural heart disease presentation. Antiarrhythmic drug therapy is the treatment of the 2nd choice in these cases. Antiarrhythmic drug therapy is the treatment of the1st choice in patients with complex supraventricular and ventricular tachyarrhythmias and plays the strategic role in hybrid therapy in combination with radiofrequency ablation or cardioverter-defibrilator implantation. The relationship between and the results of pharmacologic and nonpharmacologic studies are considered. Pharmacokinetic mechanisms and clinical effects of class IC and III antiarrhythmic drugs are described.
- MeSH
- Amiodarone administration & dosage pharmacokinetics pharmacology MeSH
- Anti-Arrhythmia Agents administration & dosage pharmacokinetics pharmacology MeSH
- Potassium Channel Blockers administration & dosage MeSH
- Calcium Channel Blockers administration & dosage pharmacokinetics pharmacology MeSH
- Sodium Channel Blockers administration & dosage MeSH
- Defibrillators, Implantable utilization MeSH
- Catheter Ablation methods MeSH
- Humans MeSH
- Propafenone administration & dosage pharmacokinetics pharmacology MeSH
- Sotalol administration & dosage pharmacokinetics pharmacology MeSH
- Arrhythmias, Cardiac etiology drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
