What question did this study set out to answer?

To determine the incidence, timing, and clinical predictors of adverse cardiac events requiring intervention during the initiation of antiarrhythmic drug therapy for atrial fibrillation.

August 15, 1997Annals of Internal Medicine

Risk of Initiating Antiarrhythmic Drug Therapy for Atrial Fibrillation in Patients Admitted to a University Hospital

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Why the study?

What is the incidence and what are the predictors of adverse cardiac events during the initiation of antiarrhythmic drug therapy in patients hospitalized for atrial fibrillation?

Population

417 consecutive patients hospitalized for atrial fibrillation, undergoing a total of 597 drug trials during…

Design

Cohort

Authors

WMWilliam H. MaiselElectrophysiology

Discussion

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Implication

May warrant closer monitoring during AAD initiation in hospitalized AF patients with prior MI; leaves open need for prospective validation before practice change.

Key Points

To determine the incidence, timing, and clinical predictors of adverse cardiac events requiring intervention during the initiation of antiarrhythmic drug therapy for atrial fibrillation.
Retrospective chart review of 417 consecutive patients across 550 hospitalizations who underwent 597 antiarrhythmic drug trials for atrial fibrillation at a university hospital.
Evaluated regimens including procainamide (189), quinidine (179), propafenone (110), sotalol (72), amiodarone (25), disopyramide (20), and flecainide (2), with electrical conversion in 247 trials.
Calculated daily hazard rates and used multivariable logistic regression to determine predictors of cardiac adverse events.
Adverse cardiac events occurred in 13.4% of trials (80/597) across 73 patients, with the highest risk observed within the first 24 hours of therapy.
Bradyarrhythmias were the most frequent complication (7.9%, n=47), followed by QT prolongation requiring drug discontinuation (1.5%, n=9) and ventricular arrhythmias (1.3%, n=8).
Multivariate analysis identified prior myocardial infarction as a significant predictor of adverse events (OR 1.90 [95% CI, 1.05 to 3.43]), with older age showing borderline significance (OR 1.29 per decade [95% CI, 0.97 to 1.72]).

Structured PICO

What is the incidence and what are the predictors of adverse cardiac events during the initiation of antiarrhythmic drug therapy in patients hospitalized for atrial fibrillation?

Population

417 consecutive patients hospitalized for atrial fibrillation, undergoing a total of 597 drug trials during 550 hospitalizations

Intervention

Initiation of antiarrhythmic drug therapy (procainamide, quinidine, disopyramide, propafenone, flecainide, sotalol, or amiodarone)

Outcome

Incidence of adverse cardiac events that require intervention during initiation of antiarrhythmic drug therapysafety

Initiation of antiarrhythmic drugs in hospitalized atrial fibrillation patients carries a 13.4% risk of cardiac adverse events, particularly in the first 24 hours and in patients with prior myocardial infarction, supporting the need for continuous ECG monitoring.

Cite This Study

William H. Maisel (1997) studied this question.

synapsesocial.com/papers/6a7d92fc77b363cb17b86c20 https://doi.org/10.7326/0003-4819-127-4-199708150-00004

Topics

Persistent AF management Atrial fibrillation Anticoagulation in AF

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Implication

May warrant closer monitoring during AAD initiation in hospitalized AF patients with prior MI; leaves open need for prospective validation before practice change.

Risk of Initiating Antiarrhythmic Drug Therapy for Atrial Fibrillation in Patients Admitted to a University Hospital

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Risk of Initiating Antiarrhythmic Drug Therapy for Atrial Fibrillation in Patients Admitted to a University Hospital

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

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