Efficiency and safety of using the modified protocol for the administration of the domestic class III antiarrhythmic drug for the relief of paroxysmal atrial fibrillation

Khava M. Dzaurova; Дзаурова Хава Муссаевна; Nikolay Yu. Mironov; Миронов Николай Юрьевич; Yuliia A. Yuricheva; Юричева Юлия Александровна; Vladislav V. Vlodzyanovsky; Влодзяновский Владислав Владимирович; Nataliia A. Mironova; Миронова Наталия Александровна; Lada Yu. Laiovich; Лайович Лада Юрьевна; Tatiana A. Malkina; Малкина Татьяна Анатольевна; Liudmila V. Zinchenko; Зинченко Людмила Викторовна; Sergei F. Sokolov; Соколов Сергей Федорович; Sergey P. Golitsyn; Голицын Сергей Павлович

doi:10.26442/00403660.2021.09.201008

Efficiency and safety of using the modified protocol for the administration of the domestic class III antiarrhythmic drug for the relief of paroxysmal atrial fibrillation

Authors: Dzaurova K.M.¹, Mironov N.Y.¹, Yuricheva Y.A.¹, Vlodzyanovsky V.V.¹, Mironova N.A.¹, Laiovich L.Y.¹, Malkina T.A.¹, Zinchenko L.V.¹, Sokolov S.F.¹, Golitsyn S.P.¹
Affiliations:
1. Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology
Issue: Vol 93, No 9 (2021)
Pages: 1052-1057
Section: Original articles
URL: https://journals.rcsi.science/0040-3660/article/view/82970
DOI: https://doi.org/10.26442/00403660.2021.09.201008
ID: 82970

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Abstract

Aim. Evaluation of the efficacy and safety of the modified refralon administration protocol for the relief of paroxysmal atrial fibrillation (AF).

Materials and methods. The study included 39 patients (19 men, mean age 63±12.8 years). All patients, after excluding contraindications in the intensive care unit, were injected intravenously with refralon at an initial dose of 5 mg/kg. If AF was preserved and there were no contraindications, after 15 min, repeated administration was performed at a dose of 5 mg/kg (total dose of 10 mg/kg). After another 15 min, while maintaining AF and the absence of contraindications, the third injection of the drug was performed at a dose of 10 mg/kg (total dose of 20 mg/kg). In the absence of relief and the absence of contraindications, another injection of refralon at a dose of 10 mg/kg was performed after another 15 min (in this case, the maximum total dose of 30 mg/kg was reached). After each injected bolus and before the introduction of the next one, the ECG parameters and the general condition of the patient were assessed. The patient was monitored for 24 hours to exclude the arrhythmogenic effect and other possible adverse events.

Results. Restoration of sinus rhythm (SR) was noted in 37 patients out of 39 (95%). Of these, 19 people (48.7%) had SR recovery after the administration of a minimum dose of refralone of 5 mg/kg. The effectiveness of the total dose of 10 mg/kg was 76.9%, the dose of 20 mg/kg was 89.7%, and the dose of 30 mg/kg was 95%. Only two patients did not recover HR after administration of the maximum dose of refralon 30 mg/kg. Pathological prolongation of the QTc interval (>500 ms) was recorded in 5% of patients. Not a single case of ventricular arrhythmogenic action (induction of Torsade de pointes) has been reported. Bradyarrhythmias (pauses, bradycardia) were registered in 13% of cases, were of a transient nature.

Conclusion. Refralon has a high efficiency of relief (95%) of paroxysmal AF, while in almost half of cases (48.7%), SR recovery is achieved using the minimum dose of refralon – 5 mg/kg. Despite the prolongation of the QTc>500 ms recorded in 5% of cases, none of the patients developed Torsade de pointes after administration of the drug.

Keywords

atrial fibrillation, paroxysmal form, relief of paroxysmal form, antiarrhythmic drug, Refralon