Recurrence Of Atrial Fibrillation Flutter Research Articles

SODIUM-GLUCOSE CO-TRANSPORTER INHIBITORS AND ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

<h3>BACKGROUND</h3> Sodium-glucose co-transporter (SGLT) inhibitors reduce heart failure (HF) hospitalization and cardiovascular death in several populations, including patients with type 2 diabetes mellitus, renal impairment, HF and cardiovascular disease. The efficacy of SGLT inhibitors in patients with atrial fibrillation/flutter (AF) and their effect on incidence or recurrence of AF has yet to be systematically assessed. Our objectives were to determine whether sodium-glucose co-transporter (SGLT) inhibitors reduce atrial fibrillation/flutter (AF) and whether a history of AF modifies the effect of SGLT inhibitors on the composite of heart failure hospitalization or cardiovascular death. <h3>METHODS AND RESULTS</h3> We searched MEDLINE, Embase and CENTRAL to March 2021. Pairs of reviewers identified randomized controlled trials that compared an SGLT inhibitor to placebo or no therapy. The primary outcome was the rate of AF reported as an adverse event. The secondary outcome was a composite of hospitalization/urgent visit for HF or cardiovascular death, stratified by history of AF at baseline. We assessed risk of bias using the Cochrane tool and the overall quality of evidence using GRADE. Thirty eligible trials reported on AF events (71,553 participants, mean age 62 years, 35.6% women). Moderate quality evidence supported a lower risk of AF events with SGLT inhibitors (1.0% versus 1.4%; risk ratio 0.78; 95% confidence interval [CI] 0.68-0.89; I2=0%). Three trials reported on the secondary composite outcome (18,826 participants, mean age 66 years, 38.1% women). In patients with a history of AF, SGLT inhibitors resulted in a lower risk in the composite of HF hospitalization or cardiovascular death (hazard ratio [HR] 0.70; 95% CI 0.57-0.85; I2=0%) – similar to the effect estimate for patients without AF (HR 0.70; 95% CI 0.61-0.79; I2=0%), p-value for interaction: 1.00. <h3>CONCLUSION</h3> SGLT inhibitors may reduce the incidence or recurrence of AF. These drugs reduce a composite of HF hospitalization or cardiovascular death, both in patients with and without AF.

P1903Efficacy and safety of dronedarone after recent cardioversion in patients with atrial fibrillation/flutter: a post-hoc analysis of the EURIDIS/ADONIS trials

Abstract Background Cardioversion is commonly performed prior to antiarrhythmic drug initiation for atrial fibrillation/flutter (AF). There are limited data describing baseline differences in patients requiring cardioversion to maintain sinus rhythm compared to those who do not. Likewise, response to antiarrhythmic drugs, including dronedarone, specifically in patients requiring cardioversion has not been well defined. Purpose To evaluate efficacy and safety of dronedarone versus placebo in patients with non-permanent AF who had cardioversion within 5 days prior to randomization in EURIDIS/ADONIS. Methods To qualify for enrolment in EURIDIS/ADONIS patients were required to be in sinus rhythm for at least 1 hour preceding randomization. Of 1237 patients randomized (2:1 dronedarone to placebo), 364 needed cardioversion for study entry (dronedarone 243, placebo 121). AF recurrence was evaluated by ECG obtained during study visits, scheduled transtelephonic monitoring, or at symptom recurrence. Results Cardioversion patients were more likely to have rheumatic heart disease, valvular heart disease, any structural heart disease, and heart failure. Nonetheless, the median time to 1st AF recurrence was longer for dronedarone versus placebo both in cardioversion patients (50 versus 15 days, hazard ratio 0.76, 95% CI 0.59, 0.97) and no cardioversion patients (150 versus 77 days, hazard ratio 0.76, 95% CI 0.64, 0.90), as was time to 1st symptomatic recurrence (cardioversion: 347 versus 87 days, hazard ratio 0.65, 95% CI 0.49, 0.87; no cardioversion: 288 versus 120 days, hazard ratio 0.74, 95% CI 0.62, 0.90) (Figure 1). There was a trend towards fewer 1st AF hospitalizations within 12 months for dronedarone versus placebo (7.8 versus 12.4%, hazard ratio 0.60, 95% CI 0.31, 1.18 in cardioversion patients; 8.4 versus 10.4%, hazard ratio 0.74, 95% CI 0.47, 1.17 in no cardioversion patients). In cardioversion patients, rates of treatment-emergent adverse events with dronedarone versus placebo were 64 versus 66%, serious treatment-emergent adverse events were 19 versus 26%, permanent discontinuations were 9 versus 6%, and deaths were 0 versus 1%. Conclusions 1) Cardioversion-requiring patients have more baseline structural heart disease and overall shorter time to AF recurrence. 2) Dronedarone effectively delayed 1st AF recurrence versus placebo in patients with or without recent cardioversion. 3) Safety of dronedarone in cardioversion patients was similar to placebo and overall observations from EURIDIS/ADONIS despite baseline differences in comorbidities. Acknowledgement/Funding Sanofi, New York, New York, United States of America

911-36 Safety and Efficacy of Sotalol in Drug Refractory Atrial Fibrillation/Flutter

The clinical efficacy and safety of oral Sotalol in patients (pts) with refractory atrial fibrillation/flutter (AF) has not been widely examined. We evaluated 31 pts with chronic (8 pts) or paroxysmal (23 pts) AF, 20 males, mean age 61 ± 8 yrs, LV ejection fraction was &lt; 40 in 11 pts, coronary artery disease in 11 pts, cardiomyopathy in 5 pts, valvular heart disease in 3 pts, no structural heart disease in 12 pts. All pts had failed multiple 2.7 (range 1 – 4) antiarrhythmic drug trials. Oral Sotalol therapy was commenced during AF in 15 pts and in sinus rhythm in 16 pts and was titrated to maximally tolerated or effective levels. All pts underwent 24 hr Holter monitor prior to discharge. Sotalol resulted in conversion to sinus rhythm in 12 of 15 (80%) pts. 2 pts had recurrent AF. and 1 pt developed side effects while in the hospital. 28 pts were discharged on a mean dose of 220 mg daily (range 80 – 320). During followup of 8.2 mas (range 2 – 20) there were no sudden or cardiac deaths. None of the pts demonstrated proarrhythmia on Holter monitor. 4 pts (12%) had recurrence of AF. Sotalol was discontinued in 3 pts (S%) due to side effects. 22 of 31 pts (71%1 were free of recurrent AF and side effects during followup. (1) Sotalol is effective, safe and well tolerated for acute conversion of AF to sinus rhythm as well as maintenance of sinus rhythm. (2) Incidence of adverse effects including proarrhythmia is low in this pt population. (3) Effective dose of Sotalol for control of AF seems to be lower than for ventricular tachycardia.