Andrei V. Syrov
Abstract
Atrial fibrillation (AF) is the most common heart rhythm disorder requiring treatment and is associated with an increased rate of hospitalization and death. When choosing the tactics of restoring and maintaining sinus rhythm in most patients with AF paroxysm without pronounced organic heart damage, the drug of choice is propafenone, which has a high level of safety and efficacy. The use of the drug within the framework of a «pill in a pocket» by the patient himself, intravenously in a day hospital of an outpatient medical institution or by an ambulance team allows stopping AF paroxysm in most patients at the prehospital stage. Propafenone is also the drug of choice for inpatient sinus rhythm restoration and for long-term antiarrhythmic therapy in a wide range of patients with AF.
Key words: atrial fibrillation, pharmacological cardioversion, antiarrhythmic therapy, propafenone.
About the Author
Andrei V. Syrov 1 21 Moscow Consultative and Diagnostic Center №6, Moscow, Russia
2 People’s Friendship University of Russia, Moscow, Russia
References
1. Fibrilliatsiia i trepetanie predserdii. Rekomendatsii VNOK, VNOA i ASSKh. 2020 g. https://webmed.irkutsk.ru/doc/pdf/fedaf.pdf (in Russian).]
2. 2020 Guidelines for of Atrial Fibrillation. ESC Clinical Practice Guidelines. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Atrial-Fibrillation-Management
3. Zulkifly H, Lip G, Lane D. Epidemiology of atrial fibrillation. Int J Clin Pract 2018; 72 (3): 13070. DOI: 10.1111/ijcp.13070
4. AFFIRM Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002; 347: 1825–33.
5. Olshansky B, Rosenfeld LE, Warner AL et al. AFFIRM Investigators. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study: approaches to control rate in atrial fibrillation. J Am Coll Cardiol 2004; 43 (7): 1201–8.
6. Karamichalakis N, Letsas K, Vlachos K et al. Managing atrial fibrillation in the very elderly patient: challenges and solutions. Vasc Health Risk Manag 2015; 11: 555–62.
7. Van Gelder IC, Hagens VE, Bosker HA et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002; 347: 1834–40.
8. Roy D, Talajic M, Nattel S et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 2008; 358: 2667–77.
9. Wyse DG. Pharmacotherapy for rhythm management in elderly patients with atrial fibrillation. J Interv Card Electrophysiol 2009; 25 (1): 25–9.
10. Kerzner R, Rich M. Atrial fibrillation in the eIderly. J Ger Cardiol 2005; 2 (2): 68–73.
11. Kirchhof P, Camm AJ, Goette A et al, on behalf of the EAST-AFNET 4 Trial Investigators. Early Rhythm-Control Therapy in Patients With Atrial Fibrillation. N Engl J Med 2020; 383 (14): 1305–16.
12. Al-Khatib S, Allen LaPointe N, Chatterjee R et al. Rate- and rhythm-control therapies in patients with atrial fibrillation: a systematic review. Ann Intern Med 2014; 160 (11): 760–73.
13. Caldeira D, David C, Sampaio C. Rate versus rhythm control in atrial fibrillation and clinical outcomes: updated systematic review and meta-analysis of randomized controlled trials. Arch Cardiovasc Dis 2012; 105 (4): 226–38.
14. Carlsson J, Miketic S, Windeler J et al; STAF Investigators. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol 2003; 41 (10): 1690–6.
15. Chatterjee S, Sardar P, Lichstein E et al. Pharmacologic rate versus rhythm-control strategies in atrial fibrillation: an updated comprehensive review and meta-analysis. PACE 2013; 36 (1): 122–33.
16. Hohnloser S, Kuck K, Lilienthal J. Rhythm or rate control in atrial fibrillation--Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 2000; 356 (9244): 1789–94.
17. Sethi N, Safi S, Nielsen E et al. The effects of rhythm control strategiesversus rate control strategies for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis Systematic Reviews 2017; 6: 47. DOI: 10.1186/s13643-017-0449-z
18. Gillis A, Verma A, Talajic M et al; CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: rate and rhythm management. Can J Cardiol 201; 27: 47–59.
19. RXlist propaphenone.
20. Alboni P, Botto GL, Baldi N et al. Outpatient treatment of recent-onset atrial fibrillation with the «pill-in-the-pocket» approach. N Engl J Med 2004; 351 (23): 2384–91.
21. Antonelli D, Darawsha A, Rimbrot S et al. Propafenone dose for emergency room conversion of paroxysmal atrial fibrillation. Harefuah 1999; 136 (11): 857–9.
22. Azpitarte J, Alvarez M, Baún O et al. Value of single oral loading dose of propafenone in converting recent-onset atrial fibrillation. Results of a randomized, double-blind, controlled study. Eur Heart J 1997; 18 (10): 1649–54.
23. Boriani G, Biffi M, Capucci A et al. Oral loading with propafenone: a placebo-controlled study in elderly and nonelderly patients with recent onset atrial fibrillation. Pacing Clin Electrophysiol 1998; 21 (11Pt2): 2465–9.
24. Boriani G, Martignani C, Biffi M et al. Oral loading with propafenone for conversion of recent-onset atrial fibrillation: a review on in-hospital treatment. Drugs 2002; 62 (3): 415–23.
25. Blanc J, Voinov C, Maarek M. Comparison of oral loading dose of propafenone and amiodarone for converting recent-onset atrial fibrillation. PARSIFAL Study Group. Am J Cardiol 1999; 84 (9): 1029–32.
26. Botto G, Capucci A, Bonini W et al. Conversion of recent onset atrial fibrillation to sinus rhythm using a single oral loading dose of propafenone: comparison of two regimens. Int J Cardiol 1997; 58 (1): 55–61.
27. Capucci A, Villani GQ, Aschieri D, Piepoli M. Safety of oral propafenone in the conversion of recent onset atrial fibrillation to sinus rhythm: a prospective parallel placebo-controlled multicentre study. Int J Cardiol 1999; 68 (2): 187–96. Erratum in: Int J Cardiol 1999; 70 (2): 213.
28. Martignani C, Diemberger I, Ziacchi M et al. Oral loading of propafenone: restoring its role before restoring rhythm. Europace 2017; 19 (11): 1903.
29. Khan IA. Single oral loading dose of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation. J Am Coll Cardiol 2001; 37 (2): 542–7.
30. Hughes C, Sunderji R, Gin K. Oral propafenone for rapid conversion of recent onset atrial fibrillation--a review. Can J Cardiol 1997; 13 (9): 839–42.
31. Antonelli D, Freedberg NA, Feldman A et al. Intravenous propafenone for conversion of atrial fibrillation in the emergency room. Harefuah 2004; 143 (7): 471–4.
32. Boriani G, Capucci A, Lenzi T et al. Propafenone for conversion of recent-onset atrial fibrillation. A controlled comparison between oral loading dose and intravenous administration. Chest 1995; 108 (2): 355–8.
33. Capucci A, Boriani G. Intravenous administration of propafenone. J Am Coll Cardiol 1992; 19 (6): 1368–9.
34. Cointe R, Metge M, Bru P et al. Intravenous and oral propafenone in the treatment and prevention of paroxysmal atrial fibrillation. Ann Cardiol Angeiol (Paris) 1993; 42 (4): 223–7.
35. Carerj S, Cavalli G, Magazù A et al. Treatment of recent atrial fibrillation with intravenous propafenone. Cardiologia 1989; 34 (1): 83–5.
36. Goy J, Métrailler J, Humair L, de Torrenté A. Restoration of sinus rhythm in atrial fibrillation of recent onset using intravenous propafenone. Am Heart J 1991; 122 (6): 1788–90.
37. Haefeli EW, Vozeh S, Ha HR, Follath F. Comparison of the pharmacodynamic effects of intravenous and oral propafenone. Clin Pharmacol Ther 1990; 48 (3): 245–54.
38. Liguori A, di Ieso N, D'Armiento F et al. Intravenous propafenone for suppression of symptomatic atrial fibrillation and atrial flutter in a first aid hospital. Riv Eur Sci Med Farmacol 1992; 14 (4): 229–32.
39. Madonia S, De Simone M, Brai G et al. Intravenous versus oral initial load of propafenone for conversion of recent-onset atrial fibrillation in the emergency room: a randomized trial. Ital Heart J 2000; 1 (7): 475–9.
40. Margheri M, Fradella G, Maioli M et al. Efficacy of intravenous and per os propafenone in the ambulatory treatment of recent-onset atrial fibrillation. G Ital Cardiol 1992; 22 (3): 257–65.
41. Velázquez Rodríguez E, Cancino Rodríguez C, Arias Estrada S et al. Pharmacological cardioversion with intravenous propafenone in atrial fibrillation. Arch Inst Cardiol Mex 2000; 70 (2): 160–6.
42. Zadura M, Grossmann G, Modrzewska A et al. Comparison of efficacy, safety and cost-effectiveness of intravenous versus oral propafenone in paroxysmal atrial fibrillation. Pol Merkur Lekarski 2001; 11 (62): 137–9.
43. Antman EM, Beamer AD, Cantillon C et al. Long-term oral propafenone therapy for suppression of refractory symptomatic atrial fibrillation and atrial flutter. J Am Coll Cardiol 1988; 12 (4):
1005–11.
44. Porterfield J, Porterfield L. Therapeutic efficacy and safety of oral propafenone for atrial fibrillation. Am J Cardiol 1989; 63 (1): 114–6. Am J Cardiol 2004; 94 (5): 663–5.
45. Kelly J, DeVore A, Wu J et al. Rhythm Control Versus Rate Control in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: Insights From Get With The Guidelines – Heart Failure. J Am Heart Assoc 2019; 8: 011560.DOI:10.1161/ JAHA.118.011560
46. Kowey PR, Yannicelli D, Amsterdam E; COPPA-II Investigators. Effectiveness of oral propafenone for the prevention of atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2004; 94 (5): 663–5.
47. Darby A, DiMarco J. Management of Atrial Fibrillation in Patients With Structural Heart Disease. Circulation 2012; 125: 945–57.
48. Fomina I.G., Tarzimanova A.I., Vertluzhskii A.V. et al. Propafenon pri vosstanovlenii sinusovogo ritma u bol'nykh s persistiruiushchei formoi fibrilliatsii predserdii. PROMETEI – otkrytoe, mul'titsentrovoe, pilotnoe issledovanie v Rossiiskoi Federatsii. Kardiovaskuliarnaia terapiia i profilaktika. 2005; 4 (4): 66–9 (in Russian).
49. Miller O.N., Starichkov S.A., Pozdniakov et al. Effektivnost' i bezopastnost' primeneniia propafenona (Propanorma®) i amiodarona (Kordarona®) u bol'nykh s fibrilliatsiei predserdii na fone AG, IBS i KhSN s sokhranennoi sistolicheskoi funktsiei LZh. Mnogotsentrovoe otkrytoe randomizirovannoe, prospektivnoe, sravnitel'noe issledovanie PROSTOR. Rossiiskii kardiologicheskii zhurnal. 2010; 4: 56–72 (in Russian).
50. Tarasov A.V., Kosykh S.A, Bushueva E.V. et al. Sravnenie effektivnosti in"ektsionnykh form antiaritmicheskikh preparatov propafenona i amiodarona pri provedenii farmakologicheskoi kardioversii paroksizmal'noi fibrilliatsii predserdii. Consilium Medicum. 2019; 1: 81–6 (in Russian).
51. Luk'ianova I.Iu., Kuznetsov A.V., Komarnitskii V.M., Kozyreva A.G. Izuchenie effektivnosti i bezopasnosti preparatov dlia medikamentoznoi kardioversii u bol'nykh s paroksizmal'noi formoi fibrilliatsii predserdii na dogospital'nom etape. Skoraia meditsinskaia pomoshch'. 2017; 4: 43–7 (in Russian).
52. Podzolkov V.I., Tarzimanova A.I. Izmenenie funktsii endoteliia u patsientov s paroksizmal'noi formoi fibrilliatsii predserdii pri lechenii propafenonom. Kardiovaskuliarnaia terapiia i profilaktika. 2018; 17 (4): 40–5 (in Russian).
53. Oganov R.G., Simanenkov V.I., Bakulin I.G. et al. Komorbidnaia patologiia v klinicheskoi praktike. Algoritmy diagnostiki i lecheniia. Klinicheskie rekomendatsii. Kardiovaskuliarnaia terapiia i profilaktika. 2019; 1: 5–66 (in Russian).
54. Lafuente-Lafuente C, Longas-Tejero MA, Bergmann JF, Belmin J. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database of Systematic Reviews 2012; 5: 1–154. DOI: 10.1002/14651858.CD005049.pub3
For citation:Syrov A.V. Pharmacological cardioversion of atrial fibrillation paroxysm in elderly and senile patients at prehospital stage. Clinical review for general practice. 2021; 3: 26–32. DOI: 10.47407/kr2021.2.3.00046
All accepted articles publish licensed under a Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.