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Efficacy and safety in pharmacological cardioversion of recent-onset atrial fibrillation: a propensity score matching to compare amiodarone vs class IC antiarrhythmic drugs

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Abstract

The acute management of recent-onset (<48 h) atrial fibrillation (AF) is still debated. Aim of our study was to compare efficacy and safety of intravenously administered class IC antidysrhythmic agents vs amiodarone in a propensity score matched series of patients acutely treated for AF in the emergency department. During a 3-year period, we retrospectively evaluated all episodes of recent-onset (<48 h) AF pharmacologically treated for sinus rhythm restoration in the emergency department. By means of a propensity score matching considering the main statistically different covariates, we selected two accurately matched treatment groups. We analysed the differences between amiodarone and class IC group in terms of efficacy and safety that is conversion to sinus rhythm rates within 12 and 48 h after starting treatment, time to conversion, and adverse drug effects. An overall number of 817 episodes of recent-onset AF were collected (amiodarone group = 406, class IC group = 411). After matching, we obtained 358 episodes equally divided (amiodarone group = 179 and class IC group = 179). Conversion rates within 12 h were 139 (53.1 %) in amiodarone group and 95 (72.6 %) in class IC group (p < 0.05). Median time for cardioversion was 420 min (331.6–508.3 CI 95 %) in amiodarone and 55 min (44.9–65.1 CI 95 %) in class IC group (p < 0.05). The incidence of adverse events in both groups was very low and equally distributed (p = ns). Intravenously administration of class IC agents, when compared with amiodarone, proved to be more rapid and effective, and equally safe in the acute management of recent-onset AF.

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Authors and Affiliations

  1. Emergency and Intensive Care Department, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy

    Antonio Bonora, Alice Dilda, Germana Zerman, Antonio Maccagnani & Claudio Pistorelli

  2. Postgraduate School of Emergency Medicine, University of Verona, Piazzale L.A. Scuro, 10, Verona, 37134, Italy

    Gianni Turcato & Gabriele Taioli

  3. Department of Cardiology, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy

    Elena Franchi

  4. Department of Internal Medicine, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy

    Oliviero Olivieri

Authors
  1. Antonio Bonora
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  2. Gianni Turcato
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  3. Elena Franchi
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  4. Gabriele Taioli
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  5. Alice Dilda
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  6. Germana Zerman
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  7. Antonio Maccagnani
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  9. Oliviero Olivieri
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Correspondence to Antonio Bonora.

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All the patients' treatments and the data collection were obtained according to the last version of the Declaration of Helsinki.

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All patients gave an informed consent regarding the treatment and the data collection which is stored in the medical record.

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Bonora, A., Turcato, G., Franchi, E. et al. Efficacy and safety in pharmacological cardioversion of recent-onset atrial fibrillation: a propensity score matching to compare amiodarone vs class IC antiarrhythmic drugs. Intern Emerg Med 12, 853–859 (2017). https://doi.org/10.1007/s11739-016-1497-4

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  • DOI: https://doi.org/10.1007/s11739-016-1497-4

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