Authors
Tyurin V.P., Pronin A.G., Prokopenko A.V., Glukhov D.K.
Pirogov National Medical and Surgical Center, Moscow
Abstract
The prevalence and recurrent course of fibrillation and atrial flutter, as well as complications developing with these cardiac arrhythmias, make the problem of finding drugs for effective and safe finish of paroxysms urgent.
Aims: to compare the efficacy and safety of drug conversion of rhythm with procainamide and niferidil in patients with atrial fibrillation and flutter.
Materials and methods: the study included 102 patients with cardiac arrhythmias of the type of atrial fibrillation or flutter. 50 patients attempted drug conversion of the rhythm with niferidil, 52 with procainamide. The frequency of sinus rhythm recovery was estimated, the reasons for the lack of effect were analyzed, and the prevalence of complications for each of the compared drugs was analyzed.
Results: it was established that in drug-induced conversion of the heart rhythm with niferidil or procainamide, the frequency of sinus rhythm recovery in patients with atrial fibrillation was almost the same, and in patients with atrial flutter, paroxysm suppression occurred much more often when using niferidil. In patients receiving niferidil, bradycardia with a heart rate of less than 60 beats per minute, frequent ventricular extrasystolia, as well as an increase in the QTc interval on ECG were more often recorded, and when procainamide is used, the lengthening of the PQ and QRS intervals is more pronounced.
Conclusions: for the relief of atrial flutter, niferedil is more effective than procainamide. But its use requires caution due to the likelihood of developing proarrhythmogenic effects.
Keywords: medical conversion of heart rhythm, procainamide, niferidil, atrial fibrillation, atrial flutter.
References
1. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 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 Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2019; 140(2): 125-151. doi: 10.1161/CIR.0000000000000665.
2. Podzolkov VI, Tarzimanova AI Antiarrhythmic therapy in the treatment of atrial fibrillation: yesterday, today, tomorrow. Cardiovascular Therapy and Prevention. 2019; 18(3): 81-87. (In Russ). doi: 10.15829/ 1728-8800-2019-3-81-87.
3. Karnik AA. Epidemiology of аtrial fibrillation and heart failure: a growing and important problem. Cardiol. Clinics. 2019; 37(2): 119-129. doi: 10.1016/j.ccl.2019.01.001.
4. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Rev. Esp Cardiol (Eng Ed). 2017; 70(1): 50. doi: 10.1016/j.rec.2016.11.033.
5. Pistoia F, Sacco S, Tiseo C, et al. The epidemiology of atrial fibrillation and stroke. Cardiol Clin. 2016; 34(2): 255-68. doi:10.1016/j.ccl.2015.12.002.
6. Komisarenko IA. Atrial fibrillation in elderly and senile patients. Clin. Gerontol. 2020; 26(1-2): 51-58. (In Russ). doi: 10.26347/1607-2499202001-02051-058.
7. Golitsyn SP, Panchenko EP, Kropacheva ES, Lajovich LYu, et al. Eurasian clinical guidelines for the diagnosis and treatment of atrial fibrillation. Moscow; 2019 (In Russ).
8. Zulkifly H, Lip GYH, Lane DA. Epidemiology of atrial fibrillation. Int. J. Clin. Practice. 2018; 72(3): e13070. doi:10.1111/ijcp.13070.
9. Potapova II, Evseychik ES. Practical recommendations and algorithms for choosing antiarrhythmic drugs for atrial fibrillation. Gomel, 2019: 38. (In Russ).
10. Revishvili ASh. Klinicheskie rekomendatsii po provedeniyu elektrofiziologicheskikh issledovanii, kateternoi ablyatsii i primeneniyu implantiruemykh antiaritmicheskikh ustroistv. Moscow: VNOA; 2017. (In Russ).
11. Miller ON, Syrov AV, Doshchitsin VL, et al. Clinical guidelines and expert opinion on the use of antiarrhythmic drugs in actual practice. Consilium Medicum. 2019; 21(5): 43-50. (In Russ). doi: 10.26442/ 20751753.2019.5.190328.
12. Maykov EB, Yuricheva YuA, Chazov EI, et al. Refralon (niferidil) is a new class III antiarrhythmic agent for pharmacological cardioversion for persistent atrial fibrillation and atrial flutter. Ther Arkh. 2015; 87(1): 38-48. (In Russ). doi:1017116/ terarkh201587138-48.
13. Mironov N, Vlodzyanovsky V, Yuricheva Yu, Sokolov S, Golitsyn S, Rosenstraukh L, Chazov E. Safety and effectiveness of pharmacological conversion and direct current cardioversion in persistent atrial fibrillation: results of randomized trial. J Am CollCardiol. 2019; 73(9): 298. doi: 10.1016/S0735-1097 (19)30906-4.
14. Revishvili ASh. Shlyahto EV, Sulimov VA, Rzaev FG, et al. Diagnostika i lechenie fibrillyacii predserdij. Klinicheskie rekomendacii. M.: VNOA; 2017: 211. (In Russ).
15. Mironov NYu, Laiovich LYu, Mironova ES, et al. Recent advances in diagnosis and management of atrial fibrillation. Therapeutic Archive. 2019; 91(6): 11-18. (In Russ). doi:10.26442/00 403660.2019.06.000295.
16. Tarasov AV, Davtyan KV, Shatakhtsyan VS. Effectiveness of antiarrhythmic therapy for different types of atrial tachyarrhythmias relapses in the early postoperative period of catheter isolation of the mouths of pulmonary veins. Cardiology and cardiovascular surgery. 2017; 2: 70-7. (In Russ). doi:1017116/kardio201710270-77.
