Cardiology > > Arrhythmias– Pacemaker, syncope rates trigger suggestions not to neglect bradycardia problem
by Nicole Lou, Senior Staff Writer, MedPage Today March 11, 2024
Old issues about the security of rhythm control drugs for atrial fibrillation (Afib or AF) resurfaced in a modern big Korean population-based research study.
Afib clients recommended antiarrhythmic drugs (AADs) had several-fold greater threats of heart occasions thought to be connected to a decrease in heart rate. Compared to other Afib clients, these AAD users revealed more regular:
- Pacemaker implantation or syncope: 16.3 vs 4.8 occasions per 1,000 person-years (changed HR 3.50, 95% CI 3.29-3.71)
- Syncope: 5.5 vs 2.6 occasions per 1,000 person-years (changed HR 2.14, 95% CI 1.95-2.35)
- Pacemaker implantation: 11.3 vs 2.2 occasions per 1,000 person-years (changed HR 5.26, 95% CI 4.86-5.70)
The association in between AADs and danger of pacemaker implantation or syncope corresponded throughout numerous subgroups. Older individuals and females appeared to be disproportionately prone to these occasions after beginning AAD treatment, reported Jong-Il Choi, MD, PhD, MHS, MSc, of Korea University College of Medicine and Korea University Anam Hospital in Seoul, and coworkers in the Journal of the American College of Cardiology
“Although rhythm control is a recognized treatment technique for clients with new-onset AF, the capacity for bradycardia-related negative results of AADs, consisting of pill-in-the-pocket method, ought to be thought about,” the authors advised.
“The progressive nature of ill sinus syndrome and atrioventricular node block is another issue for clients with AF taking extended AAD treatment,” they included.
The AADs evaluated in this research study were flecainide, propafenone, pilsicainide, amiodarone, dronedarone, and sotalol.
As a treatment for new-onset Afib, early rhythm control treatment with AADs had actually been questionable because the old AFFIRM trial revealed no clear advantage of rhythm control over rate-controlling drugs, with a mathematical excess in all-cause deaths to boot. Heart attack due to pulseless electrical activity or bradycardia was substantially more typical in the rhythm control group in AFFIRM, Choi's group kept in mind.
Quick forward almost 20 years later on, nevertheless, and EAST-AFNET 4 revealed that rhythm control, when started early in the modern age with more recent treatments, considerably lowered the danger of the composite endpoint of cardiovascular death, stroke, or hospitalization for aggravating cardiac arrest or severe coronary syndrome– the drawback being a nonsignificant pattern for more bradycardia or syncope.
The EAST-AFNET 4 trial however made AADs a mainstream treatment method for new-onset Afib in the last few years.
Today Korean research study is a pointer of the bradycardia danger being “an essential and heretofore reasonably neglected element of AAD usage,” commented a trio led by Sanjay Dixit, MD, of the Hospital of the University of Pennsylvania in Philadelphia.
“It deserves keeping in mind that although the HR of the main endpoint was greatest in the preliminary 6 months after beginning AADs, this danger continued for more than 2 years.
