2) .@SeguraCardio is discussing "Clinical Trial Data Review & Clinical Applications for Class III #Antiarrhythmic Therapeutics for Pts with #AFib." Don't miss the previous installment on this topic (still available for🆓CE/#CME) at https://t.co/dSEokiI8mH from @ValleAlfonso.
— cardio-met (@cardiomet_CE) November 29, 2023
4a) Atrial fibrillation (#AFib): the most frequent sustained arrhythmia 🌐
— cardio-met (@cardiomet_CE) November 29, 2023
Its prevalence gets 📈w/ aging 🧓& comorbidities (#hypertension, #T2DM, #heartfailure, coronary artery disease #CAD, obesity, & obstructive sleep apnea #OSA). pic.twitter.com/AD2kx1zT02
5a) There are many ways to manage it. Which recommendations do current guidelines encourage doing properly in #AFib?
— cardio-met (@cardiomet_CE) November 29, 2023
6) In this #tweetorial we are going to get a deep dive into “B”: Better Symptom Control pic.twitter.com/AWFHAsR3q3
— cardio-met (@cardiomet_CE) November 29, 2023
7b) There are several temporal #AF patterns:
— cardio-met (@cardiomet_CE) November 29, 2023
🔸#Paroxysmal
🔸Persistent
🔸Long-standing persistent
🔸Permanenthttps://t.co/nQW9mkkaFm pic.twitter.com/kK2XhnU72t
8a) How many strategies are there for "B," Better symptom control?
— cardio-met (@cardiomet_CE) November 29, 2023
9a) Let’s go w/ #rhythm control⚡️
— cardio-met (@cardiomet_CE) November 29, 2023
Strategies to restore/maintain #sinus rhythm ➡️ improve quality of life related symptoms (Class Level IA🟢).
Includes:
🔸Cardioversion
🔸Anti-arrhythmic drugs (#AAD)
🔸Pulmonary veins ablation
10) Let’s delve into #AAD pic.twitter.com/ZeZfcc6GeG
— cardio-met (@cardiomet_CE) November 29, 2023
11b) Miles Vaughan Williams (1918–2016) provided the main classification of anti-arrhythmic 💊:
— cardio-met (@cardiomet_CE) November 29, 2023
I: ❌Na+ channel
II: ❌sympathetic system 💊 (beta-blockers)
III: ❌ cardiac K+ channels to prolong repolarization
IV: ❌calcium channels & the AV nodehttps://t.co/NkG3eFnjr5 pic.twitter.com/38UgrEGpW8
12b) In #Afib the recommended anti-arrhythmic 💊 for long-term rhythm control are:
— cardio-met (@cardiomet_CE) November 29, 2023
💚Dronedarone (Class IA)
💚Flecainide (Class IA)
💚Propafenone (Class IA)
💚Amiodarone (Class IA)
💛Sotalol (Class IIb)
🔓 https://t.co/nQW9mkkaFm pic.twitter.com/afqagDW8EW
13b) Which of the following 💊 do not belong to class III? (don't Google it😉)
— cardio-met (@cardiomet_CE) November 29, 2023
13d) However, the only class III 💊 recommended for long-term rhythm control in #Afib are #Dronedarone, #Sotalol & #Amiodarone
— cardio-met (@cardiomet_CE) November 29, 2023
14b) Unlike to #amiodarone, it doesn’t have iodine⚛️, which are related to toxicity#Dronedarone also has a methyl-sulfonyl group that ⬇️ its lipophilicity & shortens its half-life to ⬇️ toxicity
— cardio-met (@cardiomet_CE) November 29, 2023
🔓 https://t.co/N8WAPbGEXS pic.twitter.com/rfT2EZHtXS
15b) Which of the following organs is rarely affected by amiodarone toxicity?
— cardio-met (@cardiomet_CE) November 29, 2023
16a) #Sotalol
— cardio-met (@cardiomet_CE) November 29, 2023
Non-selective #beta_blocker & class III 💊#Afib indications: normal LV function or w/ ischaemic heart disease (avoid if LVEF<40% or LV hypertrophy)
16c) The main concerning effect of #sotalol is the prolongation of QT interval, 📈the risk of ventricular arrhythmias.
— cardio-met (@cardiomet_CE) November 29, 2023
It must be avoided in 👥w/ hypokalemia or hypomagnesemia because it can 📈 QT interval & risk of #Torsade de pointes.
18) Compared w/ no therapy, #AAD 💊 approximately ✖️2 higher rates of sinus rhythm maintenancehttps://t.co/wd2hpvg7dj pic.twitter.com/MVd07hehyn
— cardio-met (@cardiomet_CE) November 29, 2023
20) #EURIDIS & #ADONIS studies also showed a 25%⬇️ in Afib recurrence & ⬇️ventricular rate response in those cases where #AFib recurred
— cardio-met (@cardiomet_CE) November 29, 2023
🔓 https://t.co/lUa96cyVNk pic.twitter.com/Nh9JNndKyL
21b) The 1º Endpoint of #ATHENA was the composite 1º of 🏥 due to CV events + Death from any cause, and included 4629👥 pts with paroxysmal or persistent #AFib
— cardio-met (@cardiomet_CE) November 29, 2023
21d) Secondary endpoints such as 1º 🏥 from #CV causes (26%) & death from CV causes (29%) were significantly ⬇️ pic.twitter.com/XGendR3K3J
— cardio-met (@cardiomet_CE) November 29, 2023
22b) Over the 12-week period, #AFib burden ↘️ by 54.4% (p = 0.0009)
— cardio-met (@cardiomet_CE) November 29, 2023
🔓 https://t.co/hYpATlqiRg pic.twitter.com/GwDnCkI9xC
23b) It’s b—check out #ANDROMEDA‼️
— cardio-met (@cardiomet_CE) November 29, 2023
🔸627👥 w/ LV dysfunction & heart failure (HF) NYHA class III-IV or previously hospitalised
🔸1º Endpoint: composite of death from any cause or 🏥 for HF
🔓 https://t.co/KGlLDGjd6O
23d) Moreover, during such short time follow-up, no differences were found in 1º EP or all-cause mortality pic.twitter.com/JdLXMtWLBY
— cardio-met (@cardiomet_CE) November 29, 2023
24b) It’s d, per the #PALLAS trial‼️
— cardio-met (@cardiomet_CE) November 29, 2023
🔸≥65 years👥 w/ history of permanent #Afib & risk factors for major vascular events
🔸Dronedarone vs. placebo
🔸1ºEP: Stroke, myocardial infarction, systemic embolism, or death from cardiovascular causeshttps://t.co/8FpcT5pkNx pic.twitter.com/kc4WgQ7TQt
24d) However, comedication w/ #digoxin may have ⬆️ mortality % in #PALLAS#dronedarone–digoxin pharmacokinetic interaction (dronedarone ⬇️ renal excretion of digoxin)https://t.co/hR5LfmDDBJ pic.twitter.com/zW3FNQUAno
— cardio-met (@cardiomet_CE) November 29, 2023
25a) Then, would you use #dronedarone in #HF population?
— cardio-met (@cardiomet_CE) November 29, 2023
25c) Here's a post-hoc analysis of #ATHENA, where it was analyzed the role of #dronedarone across the LVEF spectrum
— cardio-met (@cardiomet_CE) November 29, 2023
🔓 https://t.co/RK8L6jdvDc, led by @cardiomet_ce faculty @mvaduganathan pic.twitter.com/jgiJblNgfB
26) More class III AAD data!! pic.twitter.com/fkY1uJAatU
— cardio-met (@cardiomet_CE) November 29, 2023
27b) Because of its ⬇️negative inotropic & ⬇️proarrhythmic effect, it can be used in 👥 w/ #heartfailurehttps://t.co/2JcxecxBRN
— cardio-met (@cardiomet_CE) November 29, 2023
28b) Yes, we have this trial comparing both drugs
— cardio-met (@cardiomet_CE) November 29, 2023
🔸665👥 randomized to #amiodarone, #sotalol & placebo
🔸1º EP: time to recurrence of #Afib
🔓 https://t.co/KOW0T3NztK
29a) What about #amiodarone vs. #dronedarone?
— cardio-met (@cardiomet_CE) November 29, 2023
Here we have the #DYONISOS trial👇https://t.co/CtEPGepPzs
30a) A turn for #Sotalol‼️ pic.twitter.com/ho3kq6MMAi
— cardio-met (@cardiomet_CE) November 29, 2023
30c) ‼️ Be aware 🚨:
— cardio-met (@cardiomet_CE) November 29, 2023
🔸QT interval is prolonged in a dose-dependent way
🔸Close monitoring of QT interval, potassium levels, CrCl, and other proarrhythmia risk factors‼️
31b) There's no direct clinical trial comparing both 💊, but we have this interesting systematic literature review & network meta-analysis
— cardio-met (@cardiomet_CE) November 29, 2023
🔓 https://t.co/ksq2EFNmiv pic.twitter.com/vdwf1mViwo
31d) However, in the post-ablation scenario, #dronedarone ⬇️#afib recurrence vs. sotalol & had fewer #CV events
— cardio-met (@cardiomet_CE) November 29, 2023
🔓 https://t.co/0Uh6HaYj11 pic.twitter.com/MsoqJ2ZqoT
33a) What about do we compare all class III AAD 💊indicated for long-term rhythm control in #Afib? For that 39 RCTs were combined using mixed treatment comparison #MTC models
— cardio-met (@cardiomet_CE) November 29, 2023
🔓 https://t.co/H6xp0W3ORy
33c) #Dronedarone was associated w/ lowest % of #proarrhythmic events pic.twitter.com/xIWowbGFI1
— cardio-met (@cardiomet_CE) November 29, 2023
34) And that's all, folks! You just earned 0.75hr 🆓 CE/#CME. Claim it at https://t.co/g6KeYlOBzI and FOLLOW US here for more expert-authored #MedEd in the #cardiometabolic space, fully delivered on Twitter/X! Many thanks to @SeguraCardio for joining the ranks of our faculty! pic.twitter.com/MMMF8lpuX3
— cardio-met (@cardiomet_CE) November 29, 2023