DRUGS USED IN EFFECTIVE PHARMACOLOGICAL CARDIOVERSION IN PATIENTS WITHOUT PRIOR DIAGNOSIS OF ATRIAL FIBRILLATION: COMPARATIVE ANALYSIS BETWEEN 2013 AND 2017
Introduction
Atrial fibrillation (AF) is the most frequent sustained arrhythmia. It appears in all ages, being more frequent in the elderly. It is associated with significant morbidity and mortality in the form of stroke, thromboembolism andheart insufication. The treatment consists in the prevention of thromboembolic phenomena and the control of heart rate and rhythm.
Objective
To evaluate the drugs used in pharmacological cardioversion and their effectiveness with reversion to sinus rhythm in patients without prior AF in the Emergency Department ( ED) between 2012/2013 and 2017
Material and methods
Observational, retrospective study in a General Hospital with an area of 200,000 inhabitants and 275 urg / day. Patients diagnosed at the time of discharge of AF who attended ED between October 2012 and December 2013 and June 2017 to June 2017 were included. The pharmacological treatment used in 2012/2013 and 2017 was evaluated as well as the response rate of each drug used in effective pharmacological cardioversion. The statistical program SPSS was used to analyze the data
Results
A total of 1003 patients with diagnosis at discharge of AF were analyzed; 457 had in FA work and 546 failed.
In 2012/13 they consulted in one year 442 without prior FA: control of the rhythm to 89 (20.13%) with pharmacological cardioversion in 58 (65.2%).
The treatment was: Flecainide 35 (60.34%), Amiodarone 21 (36.2%), Vernakalant 3 (5.17%) and Propafenone 0.
In 41 (70.7%) they were effective. The response rate of each drug was: Flecainide 27 (77.14%), Amiodarone 12 (57.4%), Vernakalant 3 (100%) and Propafenone 0 .
In 2017, they consulted in 6 months 106 without prior FA: they performed rhythm control in 32 (30.18%) with FVC in 17 (53.12%).
The treatment was: Flecainide 9 (56.25%), Amiodarone 3 (18.75%), Vernakalant 5 (31.25%) and Propafenone 0.
In 16 (94.12%) they were effective. The response rate of each drug was: Flecainide 9 (100%), Amiodarone 2 (66.7%), Vernakalant 5 (100%) and propafenone 0.
Conclusions
The cardioversion to sinus rhythm in patients with AF of debut in the ED was performed in a greater proportion in 2017, however the pharmacological cardioversion was proportionally less in 2012/2013, being more effective in 2017.
Regarding the choice of drugs, the first choice in both years is Flecainida, with Amiodarona being the second choice in 2012/13 and Vernakalant in 2017.
In relation to the response rate, Flecainida has a good response rate, being higher in 2017, Amiodarona is similar and Vernakalant has a 100% response rate in years, with its most widespread use in 2017.
