Efficacy and safety of antazoline for cardioversion of atrial fibrillation: propensity score matching analysis of multicenter registry (CANT II Study)

• Published in: Polskie archiwum medycyny wewne̦trznej Vol. 132; no. 6
• Main Authors: Wybraniec, Maciej T, Maciąg, Aleksander, Miśkowiec, Dawid, Ceynowa-Sielawko, Beata, Balsam, Paweł, Wójcik, Maciej, Wróbel, Wojciech, Farkowski, Michał, Ćwiek-Rębowska, Edyta, Szołkiewicz, Marek, Ozierański, Krzysztof, Błaszczyk, Robert, Bula, Karolina, Dembowski, Tomasz, Peller, Michał, Krzowski, Bartosz, Wańha, Wojciech, Koziński, Marek, Kasprzak, Jarosław D, Szwed, Hanna, Mizia-Stec, Katarzyna
• Format: Journal Article
• Language: English
• Published: Poland 29.06.2022
• ISSN: 1897-9483; 1897-9483
• DOI: 10.20452/pamw.16234

Due to safety concerns about available anti-arrhythmic drugs (AAD), reliable agents for termination of atrial fibrillation (AF) are requisite. The aim of the study was to evaluate the efficacy and safety of antazoline, a first generation antihistamine, for cardioversion of recent-onset AF in the setting of emergency department. This multicentre retrospective registry covered 1365 patients (median age 69.0 (61.0-76.0) years, 53.1% men) with new-onset AF submitted to urgent pharmacological cardioversion. AAD allocation was selected by attending physician: antazoline alone was utilized in 600 patients (44%), amiodarone in 287 (21%), propafenone in 150 (11%) and ≥2 AAD in 328 patients (24%). Antazoline in monotherapy or combination was administered to 897 patients (65.7%). Matched antazoline and non-antazoline groups were identified using propensity score matching (PSM, N = 330). The primary endpoint was return of sinus rhythm within 12 hours after initiation of treatment. Before PSM, antazoline alone was superior to amiodarone [78.3% vs 66.9%; relative risk (RR) 1.17;95% confidence interval (CI) 1.07-1.28, P <0.001) and comparable to propafenone (vs 72.7%, RR 1.08, 95% CI 0.97-1.20; P = 0.14) in terms of rhythm conversion rate. In the post-PSM population, antazoline alone had higher rhythm conversion rate than non-antazoline group (84.2% vs 66.7%, RR 1.26; 95% CI 1.11-1.43, P <0.001) and comparable risk of adverse events (P = 0.2). Antazoline appears to be an efficacious agent for termination of AF in real-world setting. Randomized controlled trials are required to evaluate its safety in specific patient populations.