ANTIARRHYTHMIC THERAPY EFFECTIVENESS AND IMPACT ON LEFT VENTRICULAR DIASTOLIC FUNCTION IN PATIENTS WITH ATRIAL FIBRILLATION

Abstract

Clinical effectiveness, safety, and the impact on left ventricular (LV) systolic and diastolic function were assessed for Propanorm® and Cordarone® in patients with atrial fibrillation (AF), arterial hypertension (AH), coronary heart disease (CHD), and chronic heart failure (CHF) with preserved ejection fraction (EF). In total, 218 patients were randomised, and 189 were included in the study (132 in the Propanorm® group, and 57 in the Cordarone® group). The follow-up period lasted for 12 months. Primary end-points included all-cause mortality, cardiovascular mortality, fatal and non-fatal myocardial infarction or stroke, and hospitalisation due to decompensated CHF or recurrent AF. Secondary end-points included AF episode frequency, their duration, ventricular rate (VR) during AF paroxysms, blood pressure levels, dynamics of CHD and CHF functional class (FC), LV systolic and diastolic function, treatment safety and adverse effects in patients with CHF and preserved LV EF. At 12 months, Propanorm® effectiveness, in terms of AF paroxysm prevention, reached 61,4% and was similar to that for Cordarone®. In 31,8% of the patients from the Propanorm® group, the number of tachyarrhythmia episodes decreased by 82,4%, the total paroxysm duration was reduced by 86,6%, and VR during the paroxysm decreased by 16,1%. Improved LV diastolic filling resulted in the increased proportion of FC I CHF patients (by 50%), and reduced hospitalisation rates (by 72,9%) among the patients from the Propanorm® group. In patients with AH, CHD, and CHF with preserved LV EF, Propanorm® demonstrated a better safety profile, compared to Cordarone, since the respective adverse effect incidence was 1,5% vs. 45,6%.

Keywords

• atrial fibrillation
• chronic heart failure
• left ventricular diastolic function