Cavutilide (Refralon) for pharmacological cardioversion of early recurrence atrial fibrillation and flutter in blanking period after pulmonary veins isolation

• Published in: Evrazijskij kardiologičeskij žurnal (Online) no. 2; pp. 86 - 95
• Main Authors: Zelberg, M. A., Mironov, N. Yu, Dzaurova, Kh. M., Yuricheva, Yu. A., Maykov, E. B., Novikov, P. S., Gagloeva, D. A., Krimukova, M. A., Sokolov, S. F., Golitsyn, S. P.
• Format: Journal Article
• Language: English; Russian
• Published: InterMedservice 27.05.2024
• Subjects: atrial fibrillation; atrial flutter; cardioversion; catheter ablation; cavutilide; recurrence; refralon
• ISSN: 2225-1685; 2305-0748
• DOI: 10.38109/2225-1685-2024-2-86-95

Objective. Evaluate efficacy and safety of cavutilide (Refralon) for pharmacological cardioversion in patients with recurrent atrial fibrillation and flutter (AF/AFL), in 90days blanking period of catheter ablation. Materials and methods. included 56 patients: 46 patients with recurrent paroxysmal AF/AFL and 10 patients with recurrent persistent AF/AFL. In 45 patients (80.3%), sinus rhythm (SR) restoration was performed within 7 days from the moment of catheter ablation. Intraoperative confirmation of pulmonary vein (PV) isolation was noted in 85.7% cases (n=48). After excluding contraindications, cavutilide was administrated in the intensive care unit according to a 4-stage protocol (5 µg/kg – 5 µg/kg-10 µg/ kg – 10 µg/kg). Effectiveness of pharmacological cardioversion was assessed as the fact of restoring SR and the fact of preservation of SR 24 hours after cavutilide administration. Safety points – QT prolongation, ventricular arrhythmogenic effects, pauses and bradyarrhythmias. Results. The overall effectiveness of cavutilide among all included patients reached 98.2% (n=55), and preservation of SR 24 hours after cavutilide administration was observed in 94.5% (n=53) patients. All the patients with recurrent persistent AF/AFL successfully restored and maintained SR 24 hours after cavutilide administration 100% (n=10). In patients with recurrent paroxysmal AF/AFL restoration of SR observed in 97.8% (n=45) and preservation of SR after 24 hours – in 93.4% (n=43), respectively. The effectiveness of cavutilide did not depend on the results of the catheter ablation. Recurrences of AF/AFL after SR restoration were more common in patients without successful PV isolation. QT prolongation >500ms observed in 8.9% (n=5) of cases, including 1 case of self-terminating torsade de pointes, managed by MgSO 4 infusion. Bradyarrhythmias that did not require urgent therapy were noted in 10.7% (n=6) of cases. Conclusion . Pharmacological cardioversion with Cavutilide (Refralon) is highly effective and safe method of SR restoration in patients with recurrent AF/AFL in 90days blanking period after catheter ablation.