Factors determining the efficiency and rate of sinus rhythm recovery in pharmacological cardioversion using injectable propafenone and amiodarone


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Background. In addition to other problems, healthcare departments in the context of a coronavirus infection pandemic are also faced with a shortage in hospital beds, the workload of emergency medical services (EMS), which further actualizes the need for prehospital, quick and safe relief of paroxysms of atrial fibrillation (AF). All this emphasizes the need for EMS units to use fast-acting, effective and safe antiarrhythmic drugs to relieve AF paroxysms without hospitalization. Objective. Determination of the factors affecting the rate of sinus rhythm recovery after parenteral administration of propafenone or amiodarone in patients with AF paroxysm at the prehospital stage. Methods. The study included 388 patients: 228 (58.7%) men and 160 (41.3%) women aged 29-78 years (mean age 66.29±11.14 years) with AF paroxysm lasting an average of 195 minutes (3.25 hours). The study examined the efficacy of the injectable antiarrhythmic drug propafenone (Propanorm®) compared to injectable amiodarone (Cordarone) for the relief of paroxysmal AF within 1 hour. Statistical analysis was conducted using Statistica 10 software for Windows (StatSoft Inc., USA). Results. The relief of AF paroxysm up to 60 minutes was observed in 25.83% of patients in the amiodarone group (n=31), in 64.5% - in the propafenone group (n=173), p<0.05. In the amiodarone group, the efficacy was 61.7% (n=74), in the propafenone group - 77.6% (n=208), p=0.012. The average recovery time in the group 1 was 110 minutes, in the group 2 - 22 minutes (p=0.0001). These results clearly emphasize the greater efficiency of propafenone compared with amiodarone in the sinus rhythm recovery within 1 hour after intravenous administration in patients with paroxysmal AF. Conclusion. Injectable propafenone is a reliably effective antiarrhythmic drug for pharmacological cardioversion of paroxysmal AF at the prehospital stage for patients without organic heart diseases. However, it is advisable to continue studying this drug in aspects that determine the criteria for increasing the effectiveness of cardioversion in the shortest possible time while maintaining acceptable safety.

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作者简介

Aleksey Tarasov

National Medical Research Center for Therapy and Preventive Medicine

Email: 730tv@yandex.ru
Dr. Sci. (Med.) Head of the Department of Surgical Treatment of Complex Cardiac Arrhythmias and Cardiac Pacing Moscow, Russia

A. Redka

Voronezh Regional Clinical Hospital № 1; Voronezh State Medical University n.a. N.N. Burdenko

Voronezh, Russia

E. Shilkina

Voronezh Regional Clinical Hospital № 1; Voronezh State Medical University n.a. N.N. Burdenko

Voronezh, Russia

参考

  1. Stewart S., Hart C.L., Hole D.J., McMurray J.J. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart. 2001;86:516-21. Doi: 10.1136/ heart.86.5.516.
  2. Go A.S., Hylek E.M., Phillips K.A. et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370-75. Doi: 10.1001/ jama.285.18.2370.
  3. Miyasaka Y., Barnes M.E., Gersh B.J., et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114:119-25. doi: 10.1161/CIRCULATIONAHA.105.595140.
  4. Heeringa J., van der Kuip D.A., Hofman A., et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006;27:949-53. doi: 10.1093/eurheartj/ ehi825.
  5. Naccarelli G.V., Varker H., Lin J., Schulman K.L. Increasing prevalence of atrialfibrillation and flutter in the United States. Am J Cardiol. 2009; 104:1534-39. Doi: 10.1016/j. amjcard.2009.07.022.
  6. Диагностика и лечение фибрилляции предсердий. Рекомендации РКО и ВНОА, 2017.
  7. Coyne K.S., Paramore C., Grandy S., et al. Assessing the direct costs of treating nonvalvular atrial fibrillation in the United States. Val Health. 2006;9:348-56. doi: 10.1111/j.1524-4733.2006.00124.x.
  8. Сидоренко Б.А., Буланова Н.А. Неосложненные пароксизмы фибрилляции предсердий: частота в структуре вызовов скорой медицинской помощи и оптимальные условия купирования. Кремлевская медицина. Клинический вестник. 2015;2:17-21
  9. Kirchhof P., Benussi S., Kotecha D., et al. 2016 Esc Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. The Task Force for the management of atrial fibrillation of the ESC. Developed with the special contribution of the EHRA of the ESC. Endorsed by the ESO. Eur Heart J. 2016;37(38). Doi: 10.1093/ eurheartj/ehw210.
  10. Khan I.A. Single oral loading dose of propafenonefor pharmacological cardioversion of recent onset atrial fibrillation. J Am Coll Cardiol. 2001;37:542-doi: 10.1016/s0735-1097(00)01116-5.
  11. Миллер О.Н., Тарасов А.В., Дик И.С., Беляева И.Е. Купирование фибрилляции предсердий на догоспитальном и стационарном этапах с позиций доказательной медицины. Consilium Medicum. 2016;18(10):8-18.
  12. Клиническая рекомендация МЗ РФ «Фибрилляция и трепетание предсердий» от 2020 г
  13. Тарасов А.В., Косых С.А., Бушуева Е.В. и др. Сравнение эффективности инъекционных форм антиаритмических препаратов пропафенона и амиодарона при проведении фармакологической кардиоверсии пароксизмальной фибрилляции предсердий. Consilium Medicum. 2019;21(1):81-7
  14. Boriani G., Martignani C., Biffi M., et.al. Oral loading with propafenone for oral conversion of recent-onset atrial fibrillation. A review of in-hospital treatment. Drugs. 2002;62:415-23. doi: 10.2165/00003495200262030-00001.
  15. URL: https://www.vidal.ru/drugs/propanorm_ 44403.
  16. URL: https://www.vidal.ru/drugs/molecule/58.

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