THE USE OF ANTIARRHYTHMIC DRUGS: GUIDELINES AND ACTUAL CLINICAL PRACTICE

Cover Page

Cite item

Full Text

Abstract

Arrhythmia treatment is one of the most difficult problems in cardiology. The lack of evidence base determines the difficulty of choosing an antiarrhythmic drug (AAP) in a particular clinical situation, does not allow to fully assess the need and safety of treatment. The analysis of key studies on antiarrhythmic therapy (AAT). Detailed information on the properties, indications, contraindications, efficacy and safety of drugs widely used in Russian clinical practice, which include propafenone, amiodarone, sotalol, lappaconitine, is presented. A practical approach to the choice of AARP in various types of arrhythmias in patients without and with a pronounced organic lesion of the heart to which with regard to AAT include: unstable ischemic heart disease, myocardial infarction, low left ventricular ejection fraction <40% and left ventricular hypertrophy >15 mm. The special role of propafenone having 2 forms of oral and infusion has been analyzed. Having an evidence base makes it possible to use this drug to treat a wide range of arrhythmias, in particular, to relieve paroxysmal atrial fibrillation by the patient ("pill in pocket"), by outpatient physicians, emergency medical team and hospital in patients without pronounced organic heart disease.

About the authors

Vladimir L. Doshchitsin

Central State Medical Academy of the President of the Russian Federation

д-р мед. наук, проф. каф. терапии, кардиологии и функциональной диагностики с курсом нефрологии Москва, Россия

Andrei V. Syrov

People’s Friendship University of Russia; Consulting and diagnostic center №6, Moscow

Email: syrman2002_1@yahoo.com
канд. мед. наук, ассистент каф. общей врачебной практики Москва, Россия

Tat'iana V. Pavlova

Samara State Medical Universit

д-р мед. наук, проф. каф. кардиологии и сердечно-сосудистой хирургии Самара, Россия

References

  1. Vaughan Williams EM. J Clin Pharmacol 1984; 24: 129-47.
  2. Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989; 321: 406-12.
  3. Olshansky B, Rosenfeld LE, Warner AL et al. AFFIRM Investigators The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study: approaches to control rate in atrial fibrillation. J Am Coll Cardiol 2004; 43 (7): 1201-8.
  4. Van Gelder I, Hagens V, Kingma J et al. Rate control versus electrical cardioversion for atrial fibrillation. A randomised comparison of two treatment strategies concerning morbidity, mortality, quality of life and cost-benefit - the RACE study design. Neth Heart J 2002; 10 (3): 118-22, 123-4.
  5. Hohnloser S, Kuck K, Lilienthal J. Rhythm or rate control in atrial fibrillation--Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 2000; 356 (9244): 1789-94.
  6. Carlsson J, Miketic S, Windeler J et al. STAF Investigators. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol 2003; 41 (10): 1690-6.
  7. Roy D, Talajic M, Nattel S et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 2008; 358: 2667-77.
  8. Alboni P, Botto G, Baldi N et al. Outpation treatment of recent-onset atrial fibrillation with the "pill in pocket" approach. N Engl J Med 2004; 351: 2384-91.
  9. Сыров А.В., Поздняков Ю.М. Антиаритмическая терапия фибрилляции предсердий. Кардиология: новости, мнения,обучение. 2016; 3: 59-67. @@Syrov A.V., Pozdniakov Iu.M. Antiaritmicheskaia terapiia fibrilliatsii predserdii. Kardiologiia: novo-sti, mneniia, obuchenie. 2016; 3: 59-67 (in Russian).
  10. Lafuente-Lafuente C, Longas-Tejero M, Bergmann J, Belmin J. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev 2012; 5: CD005049.
  11. Фомина И.Г., Тарзиманова А.И., Вертлужский А.В. и др. Пропафенон при восстановлении синусового ритма у больных с персистирующей формой фибрилляции предсердий. «ПРОМЕТЕЙ» - открытое, мультицентровое, пилотное исследование в Российской Федерации. Кардиоваскулярная терапия и профилактика. 2005; 4 (4): 66-9.
  12. Boriani G, Capucci A, Lenzi T et al. Propafenone for conversion of recent-onset atrial fibrillation: a controlled comparison between oral loading dose and intravenous administration. Chest 1995; 108: 355-8.
  13. Capucci A, Villiani G, Aschieri D. Safety of oral propafenone in the convertion of recept-onset atrial fibrillation to sinus rhythm: a prospective parallel placebo - controlled multicentred study. Int J Cardiol 1999; 68: 187-96.
  14. Meinertz T, Lip G, Lombardi F et al. Efficacy and safety of propafenone sustained release in the prophylaxis of symptomatic paroxysmal atrial fibrillation (The European Rythmol/Rytmonorm Atrial Fibrillation Trial [ERAFT] Study). Am J Cardiol 2002; 90 (12): 1300-6.
  15. Khan I. Single oral loading dose of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation. J Am Coll Cardiol 2001; 37 (2): 542-7.
  16. Deneer V, Borgh M, Kingma J et al. Oral antiarrhythmic drugs in converting recent onset atrial fibrillation. Pharm World Sci 2004; 26 (2): 66-78.
  17. Antonelli D, Darawsha A, Rimbrot S et al. Propafenone dose for emergency room conversion of paroxysmal atrial fibrillation. Harefuah 1999; 136 (11): 857-9.
  18. Лукьянова И.Ю., Кузнецов А.В., Комарницкий В.М., Козырева А.Г. Изучение эффективности и безопасности препаратов для медикаментозной кардиоверсии у больных с пароксизмальной формой фибрилляции предсердий на догоспитальном этапе. Скорая медицинская помощь. 2017; 4: 43-7.
  19. AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.
  20. Диагностика и лечение фибрилляции предсердий. Клинические рекомендации Всероссийского научного общества специалистов по клинической электрофизиологии, аритмологии и электрокардиостимуляции (ВНОА) в сотрудничестве с Российским кардиологическим обществом (РКО) и Ассоциацией сердечно-сосудистых хирургов России (АССХ), 2017.
  21. ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC).
  22. Bellandi F, Simonetti I, Leoncini M et al. Long-term efficacy and safety of propafenone and sotalol for the maintenance of sinus rhythm after conversion of recurrent symptomatic atrial fibrillation. Am J Cardiol 2001; 88 (6): 640-5.
  23. Миллер О.Н., Старичков С.А., Поздняков Ю.М. и др. Эффективность и безопасность применения пропафенона (Пропанорма®) и амиодарона (Кордарона®) у больных с фибрилляцией предсердий на фоне АГ, ИБС и ХСН с сохраненной систолической функцией ЛЖ. Многоцентровое открытое рандомизированное, проспективное, сравнительное исследование ПРОСТОР. Рос. кардиол. журн. 2010; 4: 56-72.
  24. Fetsch T, Bauer P, Engberding R et al. Prevention of atrial fibrillation after cardioversion: results of the PAFAC trial. Eur Heart J 2004; 25: 1385-94.
  25. Kuhlkamp V, Mewis C, Mermi J е al. Suppression of sustained ventricular tachyarrhythmias: a comparison of d,l-sotalol with no antiarrhythmic drug treatment. J Am Coll Cardiol 1999; 33: 46-52.
  26. Waldo A, Camm A, de Ruyter H et al. Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators. Survival With Oral d-Sotalol. Lancet 1996; 348: 7-12.
  27. RxList, amiodarone.
  28. Julian DG, Camm AJ, Frangin G et al., for the European Myocardial Infarct Amiodarone Trial Investigators. Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. Lancet 1997; 349: 667-74.
  29. Cairns J, Connolly S, Roberts R, Gent M. Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators. Lancet 1997; 349 (9053): 675-82.
  30. Bardy G, Lee K, Mark D et al. Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005; 20: 352 (3): 225-37.
  31. Piccini J, Berger J, O’Connor C. Amiodarone for the prevention of sudden cardiac death: a metaanalysis of randomized controlled trials. Eur Heart J 2009; 30: 1245-53.
  32. Коморбидная патология в клинической практике. Клинические рекомендации. Кардиоваскулярная терапия и профилактика. 2019; 18 (1): 5-66.

Copyright (c) 2019 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies