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