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Clinical Characteristics of Atrial Flutter and Its Response to Pharmacological Cardioversion with Amiodarone in Comparison to Atrial Fibrillation

Background: Unlike atrial fibrillation (AF), atrial flutter (AFl) is thought to be relatively refractory to pharmacological cardioversion (PC), but the evidence is scarce. The aim of this study was to evaluate the clinical characteristics and efficacy of the PC of AFl with amiodarone in comparison t...

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Autores principales: Wybraniec, Maciej T., Górny, Kamil, Jabłoński, Kamil, Jung, Julia, Rabtsevich, Kiryl, Szyszka, Przemysław, Wesołek, Fabian, Bula, Karolina, Cichoń, Małgorzata, Wróbel, Wojciech, Mizia-Stec, Katarzyna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342954/
https://www.ncbi.nlm.nih.gov/pubmed/37445297
http://dx.doi.org/10.3390/jcm12134262
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author Wybraniec, Maciej T.
Górny, Kamil
Jabłoński, Kamil
Jung, Julia
Rabtsevich, Kiryl
Szyszka, Przemysław
Wesołek, Fabian
Bula, Karolina
Cichoń, Małgorzata
Wróbel, Wojciech
Mizia-Stec, Katarzyna
author_facet Wybraniec, Maciej T.
Górny, Kamil
Jabłoński, Kamil
Jung, Julia
Rabtsevich, Kiryl
Szyszka, Przemysław
Wesołek, Fabian
Bula, Karolina
Cichoń, Małgorzata
Wróbel, Wojciech
Mizia-Stec, Katarzyna
author_sort Wybraniec, Maciej T.
collection PubMed
description Background: Unlike atrial fibrillation (AF), atrial flutter (AFl) is thought to be relatively refractory to pharmacological cardioversion (PC), but the evidence is scarce. The aim of this study was to evaluate the clinical characteristics and efficacy of the PC of AFl with amiodarone in comparison to AF. Materials and methods: This retrospective study covered 727 patients with urgent consult for AF/AFl in a high-volume emergency department between 2015 and 2018. AFl was diagnosed in 222 (30.5%; median age: 68 (62; 75) years; 65.3% men). In a nested case-control study, 59 control patients with AF, matched in terms of age and sex with 60 AFl patients, were subject to PC with amiodarone. The primary endpoint was return of sinus rhythm confirmed using a 12-lead ECG. Results: The AFl population had a median CHA2DS2-VASc score of 3 (2; 4) and episode duration of 72 h (16; 120). In the AFl cohort, 36% of patients were initially subject to PC, 33.3% to electrical cardioversion (EC) and 40.5% to catheter ablation. In comparison to the AF group, the AFl patients required a longer hospitalization time, had a higher rate of EC (p < 0.001) and less frequent use of PC (p < 0.001) and, lower left ventricular ejection fraction (p < 0.001) and more pronounced cardiovascular risk factors. The efficacy of PC with amiodarone was significantly lower in AFl than AF group (39% vs. 65%, relative risk (RR) 0.60, p = 0.007). Conclusions: AFl patients shared a greater burden of comorbidities than AF patients, while the efficacy of PC in AFl was low. Patients should be initially managed with primary electrical cardioversion.
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spelling pubmed-103429542023-07-14 Clinical Characteristics of Atrial Flutter and Its Response to Pharmacological Cardioversion with Amiodarone in Comparison to Atrial Fibrillation Wybraniec, Maciej T. Górny, Kamil Jabłoński, Kamil Jung, Julia Rabtsevich, Kiryl Szyszka, Przemysław Wesołek, Fabian Bula, Karolina Cichoń, Małgorzata Wróbel, Wojciech Mizia-Stec, Katarzyna J Clin Med Article Background: Unlike atrial fibrillation (AF), atrial flutter (AFl) is thought to be relatively refractory to pharmacological cardioversion (PC), but the evidence is scarce. The aim of this study was to evaluate the clinical characteristics and efficacy of the PC of AFl with amiodarone in comparison to AF. Materials and methods: This retrospective study covered 727 patients with urgent consult for AF/AFl in a high-volume emergency department between 2015 and 2018. AFl was diagnosed in 222 (30.5%; median age: 68 (62; 75) years; 65.3% men). In a nested case-control study, 59 control patients with AF, matched in terms of age and sex with 60 AFl patients, were subject to PC with amiodarone. The primary endpoint was return of sinus rhythm confirmed using a 12-lead ECG. Results: The AFl population had a median CHA2DS2-VASc score of 3 (2; 4) and episode duration of 72 h (16; 120). In the AFl cohort, 36% of patients were initially subject to PC, 33.3% to electrical cardioversion (EC) and 40.5% to catheter ablation. In comparison to the AF group, the AFl patients required a longer hospitalization time, had a higher rate of EC (p < 0.001) and less frequent use of PC (p < 0.001) and, lower left ventricular ejection fraction (p < 0.001) and more pronounced cardiovascular risk factors. The efficacy of PC with amiodarone was significantly lower in AFl than AF group (39% vs. 65%, relative risk (RR) 0.60, p = 0.007). Conclusions: AFl patients shared a greater burden of comorbidities than AF patients, while the efficacy of PC in AFl was low. Patients should be initially managed with primary electrical cardioversion. MDPI 2023-06-25 /pmc/articles/PMC10342954/ /pubmed/37445297 http://dx.doi.org/10.3390/jcm12134262 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wybraniec, Maciej T.
Górny, Kamil
Jabłoński, Kamil
Jung, Julia
Rabtsevich, Kiryl
Szyszka, Przemysław
Wesołek, Fabian
Bula, Karolina
Cichoń, Małgorzata
Wróbel, Wojciech
Mizia-Stec, Katarzyna
Clinical Characteristics of Atrial Flutter and Its Response to Pharmacological Cardioversion with Amiodarone in Comparison to Atrial Fibrillation
title Clinical Characteristics of Atrial Flutter and Its Response to Pharmacological Cardioversion with Amiodarone in Comparison to Atrial Fibrillation
title_full Clinical Characteristics of Atrial Flutter and Its Response to Pharmacological Cardioversion with Amiodarone in Comparison to Atrial Fibrillation
title_fullStr Clinical Characteristics of Atrial Flutter and Its Response to Pharmacological Cardioversion with Amiodarone in Comparison to Atrial Fibrillation
title_full_unstemmed Clinical Characteristics of Atrial Flutter and Its Response to Pharmacological Cardioversion with Amiodarone in Comparison to Atrial Fibrillation
title_short Clinical Characteristics of Atrial Flutter and Its Response to Pharmacological Cardioversion with Amiodarone in Comparison to Atrial Fibrillation
title_sort clinical characteristics of atrial flutter and its response to pharmacological cardioversion with amiodarone in comparison to atrial fibrillation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342954/
https://www.ncbi.nlm.nih.gov/pubmed/37445297
http://dx.doi.org/10.3390/jcm12134262
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