Key result
Intravenous antazoline achieved a higher rate of successful cardioversion for short-duration atrial fibrillation compared to amiodarone (85.3% vs 66.7%; RR 1.28; 95% CI 1.13-1.45; P<0.001).
Why the study?
Does intravenous antazoline improve successful cardioversion rates compared to other antiarrhythmic drugs in patients with short-duration atrial fibrillation in the emergency department?
Observational (n=450)
Does intravenous antazoline improve successful cardioversion rates compared to other antiarrhythmic drugs in patients with short-duration atrial fibrillation in the emergency department?
Intravenous antazoline is an effective and safe option for pharmacological cardioversion of short-duration atrial fibrillation in the emergency department, demonstrating higher success rates than amiodarone.
Antazoline may warrant consideration for short-duration AF cardioversion in the ED; observational data leaves open need for RCTs before practice change.
Background Antazoline mesylate represents an antihistamine capable of rapid and safe cardioversion of atrial fibrillation, yet evidence concerning its efficacy in comparison to other medications is insufficient. The study aimed to evaluate the success rate and safety of pharmacological cardioversion of atrial fibrillation with intravenous antazoline ( CANT [Cardioversion With Antazoline Mesylate] study) in the setting of the emergency department. Methods and Results After reviewing 1984 medical records, 450 eligible patients (22.7%) with short-duration atrial fibrillation subject to pharmacological cardioversion were enrolled in a retrospective observational analysis. The choice of antiarrhythmic drug was left to the discretion of the attending physician. The primary end point was successful cardioversion in the emergency department. The safety end point comprised bradycardia <45 bpm, hypotension, syncope, or death. The study population (mean age, 65.5±11.9 years; 52.9% females) was characterized by a median atrial fibrillation episode duration of 10 hours. Antazoline, alone or in combination, was administered in 24.2% (n=109) and 40% (n=180), respectively; amiodarone was administered in 46.7% and propafenone in 9.3%, while ≥2 antiarrhythmic drugs were administered in 19.8% of patients. Antazoline had the highest success rate of pharmacological cardioversion among all drugs (85.3%), which was comparable with propafenone (78.6%; relative risk, 1.09, 95% confidence interval, 0.91-1.30; P=0.317) and higher than amiodarone treatment (66.7%; relative risk, 1.28, 95% confidence interval, 1.13-1.45; P<0.001; number needed to treat, 5.4). The rate of cardioversion with antazoline alone was higher than combined amiodarone and/or propafenone (68.1%; relative risk, 1.25; 95% confidence interval, 1.12-1.40, P=0.0001). No safety end points were reported in the antazoline group, while 5 incidents occurred in the non-antazoline cohort ( P=0.075). Conclusions Antazoline represents an efficacious and safe method of pharmacological cardioversion in a real-life setting.
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Wybraniec et al. (2018) conducted an observational in Short-duration atrial fibrillation (n=450). Antazoline vs. Amiodarone was evaluated on Successful cardioversion in the emergency department (RR 1.28, 95% CI 1.13-1.45, p=<0.001). Intravenous antazoline achieved a higher rate of successful cardioversion for short-duration atrial fibrillation compared to amiodarone (85.3% vs 66.7%; RR 1.28; 95% CI 1.13-1.45; P<0.001).
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