Sinus Rhythm Maintenance After Electrical Cardioversion for Atrial Fibrillation in High-Risk Patients — Comparative Efficacy of Antiarrhythmic Medications

Baiba Kokina; Aldis Strēlnieks; Irina Pupkeviča; Kristīne Jubele; Maija Vikmane; Sandis Sakne; Emma Sokolova; Inga Urtāne; Aivars Lejnieks; Oskars Kalējs

doi:10.2478/prolas-2021-0006

February 1, 2021Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied SciencesOpen Access

Sinus Rhythm Maintenance After Electrical Cardioversion for Atrial Fibrillation in High-Risk Patients — Comparative Efficacy of Antiarrhythmic Medications

View Full Paper

Ask AI

Bookmark

Share

Why the study?

Preventing arrhythmia recurrence after electrical cardioversion is challenging in high-risk AF patients, and not all comparative effects of class IC, class III, and class II antiarrhythmic medications have been studied.

Does class IC antiarrhythmic therapy (specifically ethacizine with a beta-blocker) improve sinus rhythm maintenance compared to class III therapy (specifically amiodarone) in high-risk patients after electrical cardioversion for atrial fibrillation?

Structured PICO

Does class IC antiarrhythmic therapy (specifically ethacizine with a beta-blocker) improve sinus rhythm maintenance compared to class III therapy (specifically amiodarone) in high-risk patients after electrical cardioversion for atrial fibrillation?

P

Population

112 adults with high-risk non-valvular atrial fibrillation (CHA2DS2-VASc score ≥2 for men, ≥3 for women) who underwent successful electrical cardioversion. Mean age 65.5 years, 58.0% men. Single-center (Latvia).

I

Intervention

Class IC antiarrhythmic medications (used by 34.8% of patients; specifically ethacizine 25.9% concomitantly with a beta-blocker, or propafenone 8.9%)

C

Comparator

Class III antiarrhythmic medications (used by 65.2% of patients; specifically amiodarone 57.1%, or sotalol 8.0%)

O

Outcome

Sinus rhythm maintenance rate at 6-month follow-up

In high-risk patients with atrial fibrillation, ethacizine combined with a beta-blocker demonstrated comparable efficacy to amiodarone for maintaining sinus rhythm at 6 months post-cardioversion.

Implication

No practice change warranted yet in high-risk AF post-cardioversion; leaves open class IC versus class III efficacy for sinus rhythm maintenance.

Abstract

Atrial fibrillation (AF) conversion to sinus rhythm by electrical cardioversion (ECV) is followed by the challenge of preventing arrhythmia recurrence, especially in high-risk patients. The properties of class IC, class III and also class II antiarrhythmic medications have been established, but not all effects have been studied. The aim of the study was to compare efficacy of class IC and class III antiarrhythmic medications, and additionally medication with a class II mechanism of action, or taken concomitantly with a beta-blocker, for post-cardioversion sinus rhythm maintenance in patients with high-risk AF. A total of 112 patients who underwent successful ECV in Latvian Centre of Cardiology were included. Data was acquired by a face-to-face interview and 1-, 3-, 6-month follow-up interviews. Comparing class IC (used by 34.8%) and class III (used by 65.2%) drugs, there was no statistically significant difference between six-month sinus rhythm maintenance rates (53.8% vs. 63.0%, p = 0.346) and arrhythmia-free survival (p = 0.313). Comparing amiodarone (used by 57.1%) and ethacizine, concurrently with a beta-blocker (used by 25.9%), no statistically significant difference was found between six-month sinus rhythm maintenance (64.1% vs. 58.6%, p = 0.616) and arrhythmia-free survival (p = 0.706). The results showed that specific antiarrhythmic drug choice was not associated with superior effectiveness, highlighting that, if not contraindicated, ethacizine, concomitantly with a beta-blocker, could be used as a similarly effective alternative for amiodarone, which has adverse health effects.