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Arrhythmias/Electrophysiology

RCT: Propafenone leads to quicker sinus rhythm restoration than amiodarone in supraventricular arrhythmias related to septic shock

1 Oct, 2023 | 15:19h | UTC

Study Design & Population: The research was a two-center, prospective, controlled parallel-group, double-blind trial involving 209 septic shock patients who had new-onset supraventricular arrhythmia and a left ventricular ejection fraction above 35%. Patients were randomized to receive either intravenous propafenone (70 mg bolus followed by 400–840 mg/24 h) or amiodarone (300 mg bolus followed by 600–1800 mg/24 h).

Main Findings: The primary outcomes focused on the proportion of patients in sinus rhythm 24 hours post-infusion, time to the first sinus rhythm restoration, and arrhythmia recurrence rates. No significant difference was observed in 24-hour sinus rhythm rates between the propafenone (72.8%) and amiodarone (67.3%) groups (p=0.4). Time to the first rhythm restoration was significantly shorter for the propafenone group (median 3.7 hours) compared to the amiodarone group (median 7.3 hours, p=0.02). Recurrence of arrhythmia was notably lower in the propafenone group (52%) than in the amiodarone group (76%, p<0.001). In the subgroup of patients with a dilated left atrium, amiodarone appeared to be more effective.

Implications & Limitations: The study suggests that while propafenone doesn’t offer better rhythm control at 24 hours compared to amiodarone, it does provide faster cardioversion and fewer arrhythmia recurrences, especially in patients with a non-dilated left atrium. No significant differences were observed in clinical outcomes, such as ICU or long-term mortality, between propafenone and amiodarone in the trial. Limitations include potential underpowering of the study and the inability to fully account for the impact of multiple covariates involved in the complex therapy of septic shock.

Article: Balik, M., Maly, M., Brozek, T. et al. Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial. Intensive Care Med (2023)

 

Commentary on Twitter:

 


RCT – 2ry analysis | Omega-3 supplementation linked to increased AF risk in post-MI patients

3 Aug, 2023 | 13:45h | UTC

Omega-3 fatty acid supplements and risk of atrial fibrillation and ‘micro-atrial fibrillation’: A secondary analysis from the OMEMI trial – Clinical Nutrition

Related:

M-A: Omega-3 fatty acids supplementation is associated with increased risk of atrial fibrillation.

M-A: Omega-3 fatty acids supplementation increases the risk of atrial fibrillation in patients with lipid disorders.

More data suggests no cardiovascular benefit from Omega-3 supplementation – secondary analysis of STRENGHT trial did not show an association between achieved Omega-3 fatty acid levels and major adverse cardiovascular outcomes in patients with high cardiovascular risk.

RCT: Omega-3 supplements do not reduce cardiovascular events in elderly patients after myocardial infarction

#AHA20 – Randomized trial: High-dose Omega-3 fatty acids did not reduce the risk of cardiac events in patients at high cardiovascular risk

Meta-Analysis of Randomized Trials: Little Benefit from Omega-3 Intake to Reduce Cardiovascular Disease Risk

 

Commentary from the author on Twitter (thread – click for more)

 


RCT | High-power radiofrequency improves AF ablation results vs. standard-power, but may increase asymptomatic cerebral emboli

26 Jul, 2023 | 13:16h | UTC

A Randomized Trial of High vs Standard Power Radiofrequency Ablation for Pulmonary Vein Isolation: SHORT-AF – JACC: Clinical Electrophysiology (link to abstract – $ for full-text)

Commentary: A Randomized Trial of High vs Standard Power Radiofrequency Ablation for Pulmonary Vein Isolation – SHORT-AF – American College of Cardiology

 


RCT | Self-administered intranasal etripamil superior to placebo for acute supraventricular tachycardia conversion

12 Jul, 2023 | 13:54h | UTC

Self-administered intranasal etripamil using a symptom-prompted, repeat-dose regimen for atrioventricular-nodal-dependent supraventricular tachycardia (RAPID): a multicentre, randomised trial – The Lancet

 


RCT | Supplementing CPVI with low-voltage-area ablation lowers atrial arrhythmia recurrence in elderly with paroxysmal AF

12 Jul, 2023 | 13:31h | UTC

Circumferential Pulmonary Vein Isolation With vs Without Additional Low-Voltage-Area Ablation in Older Patients With Paroxysmal Atrial Fibrillation: A Randomized Clinical Trial – JAMA Cardiology (link to abstract – $ for full-text)

See also: Visual Abstract

 


Review | Management of premature ventricular complexes in the outpatient setting

7 Jul, 2023 | 16:22h | UTC

Management of Premature Ventricular Complexes in the Outpatient Setting – Mayo Clinic Proceedings

 


Review | Silent cerebral lesions following catheter ablation for atrial fibrillation

29 Jun, 2023 | 13:51h | UTC

Silent cerebral lesions following catheter ablation for atrial fibrillation: a state-of-the-art review – EP Europace

 

Commentary on Twitter

 


Cohort Study | Five-year safety and efficacy of leadless pacemakers

20 Jun, 2023 | 12:40h | UTC

Five-year safety and efficacy of leadless pacemakers in a Dutch cohort – Heart Rhythm

 


SSAI Guideline | New-onset atrial fibrillation in critically ill adult patients

6 Jun, 2023 | 14:31h | UTC

New-onset atrial fibrillation in critically ill adult patients—an SSAI clinical practice guideline – Acta Anaesthesiologica Scandinavica

 


RCT | Early initiation of DOACs not statistically superior to later use in atrial fibrillation-related stroke

31 May, 2023 | 14:17h | UTC

Early versus Later Anticoagulation for Stroke with Atrial Fibrillation – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries:

ELAN: Early DOACs Safe, May Help After Ischemic Stroke in AF Patients – TCTMD

Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischemic Stroke Patients With Atrial Fibrillation – ELAN – American College of Cardiology

 

Commentary on Twitter

 


Cohort Study | Amiodarone linked to higher bleeding risk vs. flecainide or sotalol in atrial fibrillation patients on anticoagulants

30 May, 2023 | 12:01h | UTC

Risk for Bleeding-Related Hospitalizations During Use of Amiodarone With Apixaban or Rivaroxaban in Patients With Atrial Fibrillation: A Retrospective Cohort Study – Annals of Internal Medicine (link to abstract – $ for full-text)

News Release: Amiodarone used with anticoagulant therapy linked to more bleeding-related hospitalizations than flecainide or sotalol – American College of Physicians

Commentary: Amiodarone increases bleeding compared with flecainide or sotalol in patients on anticoagulant therapy – ACP Internist

 

Commentary on Twitter

 


Subepicardial Cardiomyopathy: a disease underlying J-wave syndromes and idiopathic ventricular fibrillation

29 May, 2023 | 10:38h | UTC

Subepicardial Cardiomyopathy: A Disease Underlying J-Wave Syndromes and Idiopathic Ventricular Fibrillation – Circulation

 

Commentary on Twitter

 


Consensus Statement | Management of arrhythmias during pregnancy

23 May, 2023 | 13:00h | UTC

2023 HRS Expert Consensus Statement on the Management of Arrhythmias During Pregnancy – Heart Rhythm

News Release: Management of Arrhythmias During Pregnancy Consensus Statement Emphasizes Shared Decision-Making – European Heart Rhythm

 


Consensus Statement | Practical management of the remote device clinic

23 May, 2023 | 12:58h | UTC

2023 HRS/EHRA/APHRS/LAHRS expert consensus statement on practical management of the remote device clinic – Heart Rhythm

 


Guideline | Cardiac physiologic pacing for the avoidance and mitigation of heart failure

23 May, 2023 | 12:55h | UTC

2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure – Heart Rhythm

News Release: New clinical practice guideline on cardiac physiological pacing – Elsevier

 


Atrial fibrillation incidence associated with exposure to anticancer drugs used as monotherapy in clinical trials

10 May, 2023 | 15:54h | UTC

Atrial Fibrillation Incidence Associated With Exposure to Anticancer Drugs Used as Monotherapy in Clinical Trials – JACC: CardioOncology

Editorials:

Atrial Fibrillation With Modern Cancer Treatment: More Common Than We Think – JACC: CardioOncology

Atrial Fibrillation in Patients With Cancer: A Persistent and Increasing Challenge – JACC: CardioOncology

 

Commentary on Twitter

 


Review | Causes of sudden death

9 May, 2023 | 14:16h | UTC

Causes of sudden death – European Heart Journal Supplements

See all articles in the series here

 


Review | The bidirectional association between atrial fibrillation and myocardial infarction

8 May, 2023 | 12:54h | UTC

The bidirectional association between atrial fibrillation and myocardial infarction – Nature Reviews Cardiology (if the link is paywalled, try this one)

 

Commentary on Twitter

 


M-A | Direct oral anticoagulants versus warfarin across the spectrum of kidney function in patients with AF

3 May, 2023 | 15:32h | UTC

Direct Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF – Circulation (free for a limited period)

 

Commentary on Twitter

 


Oral anticoagulation in patients with advanced CKD and atrial fibrillation: beyond anticoagulation

2 May, 2023 | 13:20h | UTC

Oral Anticoagulation in Patients With Advanced Chronic Kidney Disease and Atrial Fibrillation: Beyond Anticoagulation – Mayo Clinic Proceedings

 


RCT | Comparison of three different substrate ablation strategies for persistent atrial fibrillation

26 Apr, 2023 | 14:18h | UTC

Multi-centre, prospective randomized comparison of three different substrate ablation strategies for persistent atrial fibrillation – EP Europace

 


RCT | No difference in atrial fibrillation recurrence with early vs. delayed AF ablation at 12 months

24 Apr, 2023 | 13:49h | UTC

Impact of Early Versus Delayed Atrial Fibrillation Catheter Ablation on Atrial Arrhythmia Recurrences – European Heart Journal (link to abstract – $ for full-text. Free PDF may be available here)

 

Commentary on Twitter

 


Global Survey | Incidence, management and prognosis of esophageal fistula after atrial fibrillation catheter ablation

19 Apr, 2023 | 13:14h | UTC

A worldwide survey on incidence, management and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study – European Heart Journal

Commentary: Esophageal Fistula Still a Rare but Deadly Complication of AF Ablation: POTTER-AF – TCTMD

 

Commentary from the author on Twitter

 


EHRA expert consensus document on the management of arrhythmias in frailty syndrome

18 Apr, 2023 | 12:58h | UTC

EHRA expert consensus document on the management of arrhythmias in frailty syndrome, endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA) – EP Europace

 


Cohort Study | Value of screening for the risk of sudden cardiac death in young competitive athletes

12 Apr, 2023 | 13:11h | UTC

Value of screening for the risk of sudden cardiac death in young competitive athletes – European Heart Journal

Editorial: Optimizing pre-participation screening to prevent tragedy in young athletes: moving from if to how – European Heart Journal

 


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