2. Academic Validation
  3. Efficacy and safety of antazoline for cardioversion of atrial fibrillation: propensity score matching analysis of a multicenter registry (CANT II Study)

Efficacy and safety of antazoline for cardioversion of atrial fibrillation: propensity score matching analysis of a multicenter registry (CANT II Study)

  • Pol Arch Intern Med. 2022 Jun 29;132(6):16234. doi: 10.20452/pamw.16234.
Maciej T Wybraniec 1,  Aleksander Maciąg 2,  Dawid Miśkowiec 3 4,  Beata Ceynowa-Sielawko 5,  Paweł Balsam 3 6,  Maciej Wójcik 3 7,  Wojciech Wróbel 8,  Michał Farkowski 3 2,  Edyta Ćwiek-Rębowska 4,  Marek Szołkiewicz 5,  Krzysztof Ozierański 3 6,  Robert Błaszczyk 3 7,  Karolina Bula 8,  Tomasz Dembowski 4,  Michał Peller 6,  Bartosz Krzowski 6,  Wojciech Wańha 3 9,  Marek Koziński 3 10,  Jarosław D Kasprzak 3 4,  Hanna Szwed 11,  Katarzyna Mizia-Stec 8 3
Affiliations

Affiliations

  • 1 First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland, Upper Silesia Medical Center, Katowice, Poland; Club 30” of the Polish Cardiac Society. [email protected]
  • 2 Second Department of Heart Arrhythmia, National Institute of Cardiology, Warsaw, Poland
  • 3 Club 30” of the Polish Cardiac Society
  • 4 Department of Cardiology, Medical University of Lodz, Łódź, Poland
  • 5 Department of Cardiology and Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, Wejherowo, Poland
  • 6 First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
  • 7 Chair and Department of Cardiology, Medical University of Lublin, Lublin, Poland
  • 8 First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland, Upper Silesia Medical Center, Katowice, Poland
  • 9 Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland, Upper Silesia Medical Center, Katowice, Poland
  • 10 Department of Cardiology and Internal Medicine, Medical University of Gdansk, Gdynia, Poland
  • 11 Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warsaw, Poland
PMID: 35293200 DOI: 10.20452/pamw.16234
Abstract

Introduction: Due to safety concerns about available antiarrhythmic drugs (AADs), reliable agents for termination of atrial fibrillation (AF) are requisite.

Objectives: The aim of the study was to evaluate the efficacy and safety of antazoline, a first‑generation antihistamine, for cardioversion of recent‑onset AF in the setting of an emergency department.

Patients and methods: This multicenter, retrospective registry covered 1365 patients (median [interquartile range] age, 69.0 [61.0-76.0] years, 53.1% men) with new‑onset AF submitted to urgent pharmacological cardioversion. AAD allocation was performed by the attending physician: antazoline alone was utilized in 600 patients (44%), amiodarone in 287 (21%), propafenone in 150 (11%), and ≥2 AADs in 328 patients (24%). Antazoline in monotherapy or combination was administered to 897 patients (65.7%). Matched antazoline and nonantazoline groups were identified using propensity score matching (PSM, n = 330). The primary end point was return to sinus rhythm within 12 hours after initiation of the treatment.

Results: Before PSM, antazoline alone was superior to amiodarone (78.3% vs 66.9%; relative risk [RR], 1.17; 95% CI, 1.07-1.28; P <0.001) and comparable to propafenone (78.3% vs 72.7%; RR, 1.08; 95% CI, 0.97-1.20; P = 0.14) in terms of rhythm conversion rate. In the post‑PSM population, the rhythm conversion rate was higher among patients receiving antazoline alone than in the nonantazoline group (84.2% vs 66.7%; RR, 1.26; 95% CI, 1.11-1.43; P <0.001), and the risk of adverse events was comparable (P = 0.2).

Conclusions: Antazoline appears to be an efficacious agent for termination of AF in real‑world setting. Randomized controlled trials are required to evaluate its safety in specific patient populations.

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