Pharmacological Cardioversion in Patients with Recent-Onset Atrial Fibrillation and Chronic Kidney Disease Subanalysis of the CANT II Study

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 and Marek Szołkiewicz
Additional contact information
Beata Ceynowa-Sielawko: Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
Maciej T. Wybraniec: First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Centre, 40-635 Katowice, Poland
Aleksandra Topp-Zielińska: Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
Aleksander Maciąg: 2nd Department of Heart Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland
Dawid Miśkowiec: Club 30′ of the Polish Cardiac Society, 00-193 Warsaw, Poland
Paweł Balsam: Club 30′ of the Polish Cardiac Society, 00-193 Warsaw, Poland
Maciej Wójcik: Club 30′ of the Polish Cardiac Society, 00-193 Warsaw, Poland
Wojciech Wróbel: First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Centre, 40-635 Katowice, Poland
Michał M. Farkowski: Club 30′ of the Polish Cardiac Society, 00-193 Warsaw, Poland
Edyta Ćwiek-Rębowska: Department of Cardiology, Medical University of Lodz, 91-347 Lodz, Poland
Krzysztof Ozierański: Club 30′ of the Polish Cardiac Society, 00-193 Warsaw, Poland
Robert Błaszczyk: Club 30′ of the Polish Cardiac Society, 00-193 Warsaw, Poland
Karolina Bula: First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Centre, 40-635 Katowice, Poland
Tomasz Dembowski: Department of Cardiology, Medical University of Lodz, 91-347 Lodz, Poland
Michał Peller: 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
Bartosz Krzowski: 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
Wojciech Wańha: Club 30′ of the Polish Cardiac Society, 00-193 Warsaw, Poland
Marek Koziński: Club 30′ of the Polish Cardiac Society, 00-193 Warsaw, Poland
Jarosław D. Kasprzak: Club 30′ of the Polish Cardiac Society, 00-193 Warsaw, Poland
Hanna Szwed: Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, 04-628 Warsaw, Poland
Katarzyna Mizia-Stec: First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Centre, 40-635 Katowice, Poland
Marek Szołkiewicz: Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland

IJERPH, 2022, vol. 19, issue 8, 1-10

Abstract: Pharmacological cardioversion (PCV) is commonly a primary option for termination of recent-onset atrial fibrillation (AF) in emergency departments (ED). This is a subanalysis of the CANT II study, evaluating the effectiveness and safety of antazoline in patients ( n = 777) at three stages of chronic kidney disease (CKD): Group I > 60 mL/min ( n = 531), Group II 45–59 mL/min ( n = 149), and Group III < 45 mL/min ( n = 97). Patients in Group III were older and with a higher prevalence of co-morbidities; however, we did not find statistically significant differences in the overall effectiveness of PCV in comparison with the other groups. In patients receiving amiodarone, the PCV success rate was similar in all the studied groups, but along with a renal function decline, it decreased in patients receiving antazoline (79.1 vs. 35%; p < 0.001), and it increased almost significantly in patients receiving propafenone (69.9 vs. 100%; p = 0.067). In patients in Group I, antazoline restored a sinus rhythm as effectively as propafenone and amiodarone; however, in patients in Group III, both antazoline and amiodarone became less effective in restoring a sinus rhythm than propafenone ( p = 0.002 and p = 0.034, respectively). The rate of safety endpoint was the highest in patients in Group III (eGFR < 45 mL/min), and it was significantly higher than in patients in Groups I and II ( p = 0.008 and p = 0.036, respectively). We did not observe antazoline-related adverse events in any of the studied groups of patients. This real-world registry analysis revealed a different influence of CKD on the effectiveness of individual drugs, and while propafenone and amiodarone maintained their AF termination efficacy, antazoline became significantly less effective in restoring sinus rhythm.

Keywords: atrial fibrillation; pharmacological cardioversion; chronic kidney disease; antazoline; propafenone; amiodarone (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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