Body Weight Counts—Cardioversion with Vernakalant or Ibutilide at the Emergency Department
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Enrollment and Data Acquisition
2.2. Patient Follow-Up and Endpoint Analysis
2.3. Statistical Analysis
3. Results
3.1. Study Population
3.2. Efficacy and Effect on QTc
3.3. Correlation of Body Weight and Conversion Success
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
References
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Crude OR (95% CI) | p-Value | * Adjusted OR (95% CI) | p-Value | |
---|---|---|---|---|
BMI | 0.77 (0.58–0.99) | 0.048 | 0.77 (0.61–1.01) | 0.059 |
Height | 0.94 (0.78–1.15) | 0.150 | 0.89 (0.75–1.15) | 0.203 |
Body weight | 0.74 (0.57–0.97) | 0.029 | 0.69 (0.51–0.94) | 0.018 |
Total | Vernakalant | Ibutilide | p-Value | |
---|---|---|---|---|
Age, years (IQR) | 64 (50–73) | 62 (49–70) | 67 (52–75) | 0.003 |
Male sex, n (%) | 195 (61.7) | 116 (64.1) | 79 (58.5) | 0.314 |
Cardioversion success, n (%) | 241 (76.3) | 138 (76.2) | 103 (76.3) | 0.991 |
Height, cm (IQR) | 175 (168–183) | 176 (168–184) | 175 (165–182) | 0.159 |
Weight, kg (IQR) | 80 (71–91) | 83 (73–92) | 80 (70–91) | 0.040 |
BMI, kg/m2 (IQR) | 26.2 (23.8–29.2) | 26.3 (24.1–29.1) | 26.0 (23.0–29.4) | 0.115 |
First detected rhythm, n (%) | 0.001 | |||
Atrial fibrillation | 248 (78.5) | 180 (99.4) | 67 (49.6) | |
Atrial flutter | 68 (21.5) | 1 (0.6) | 68 (50.4) | |
Classification, n (%) | 0.441 | |||
Paroxysmal/persistent | 231 (73.1) | 133 (73.4) | 98 (72.6) | |
New onset | 27 (8.5) | 24 (13.3) | 3 (2.2) | |
Not known | 58 (18.4) | 24 (13.3) | 34 (25.2) | |
Comorbidities, n (%) | ||||
Arterial hypertension | 161 (50.9) | 99 (54.7) | 62 (45.9) | 0.123 |
Heart failure | 16 (5.1) | 6 (3.3) | 10 (7.4) | 0.101 |
Coronary heart disease | 23 (7.3) | 19 (10.5) | 4 (3.0) | 0.011 |
Prior stroke/TIA | 23 (7.3) | 14 (7.7) | 9 (6.7) | 0.718 |
Vascular disease | 26 (8.2) | 14 (7.7) | 12 (8.9) | 0.712 |
Diabetes mellitus | 19 (6.0) | 13 (7.2) | 6 (4.4) | 0.312 |
Hyperlipidemia | 77 (24.4) | 51 (28.2) | 26 (19.3) | 0.068 |
Long-term medication, n (%) | ||||
Beta blocker | 145 (45.9) | 88 (48.6) | 57 (42.2) | 0.260 |
Amiodarone | 15 (4.7) | 11 (6.1) | 4 (3.0) | 0.198 |
Digitalis | 5 (1.6) | 1 (0.6) | 4 (3.0) | 0.090 |
Flecanide | 12 (3.8) | 4 (2.2) | 8 (5.9) | 0.088 |
Dronedarone | 2 (0.6) | 1 (0.6) | 1 (0.7) | 0.835 |
Propafenone | 1 (0.3) | 1 (0.6) | 0 (0.0) | 0.388 |
Ca-channel inhibitors | 42 (13.3) | 25 (13.8) | 17 (12.6) | 0.752 |
Alpha blockers | 11 (3.5) | 9 (5.0) | 2 (1.5) | 0.095 |
ACE inhibitors | 45 (14.2) | 31 (17.1) | 14 (10.4) | 0.090 |
AT2 inhibitors | 90 (28.5) | 54 (29.5) | 36 (26.7) | 0.538 |
Diuretics | 64 (20.3) | 31 (17.1) | 33 (24.4) | 0.110 |
Lipid-lowering agents | 62 (19.6) | 46 (25.4) | 16 (11.9) | 0.003 |
P2Y12 antagonists | 14 (4.4) | 11 (6.1) | 3 (2.2) | 0.100 |
Acetylsalicylic acid | 52 (16.5) | 41 (22.7) | 11 (8.1) | 0.001 |
Phenprocoumon | 45 (14.2) | 18 (9.9) | 27 (20) | 0.012 |
NOACs | 78 (24.7) | 44 (24.3) | 34 (25.2) | 0.866 |
LMWH | 4 (1.3) | 4 (2.2) | 0 (0.0) | 0.083 |
Vernakalant Population | |||
Treatment Success | No Treatment Success | p-Value | |
Arterial hypertension, n (%) | 76 (55.1) | 23 (53.5) | 0.856 |
Heart failure, n (%) | 0 (0.0) | 6 (14.0) | 0.001 |
Coronary heart disease, n (%) | 13 (9.4) | 6 (14.0) | 0.398 |
Prior stroke/TIA, n (%) | 10 (7.2) | 4 (9.3) | 0.660 |
Vascular disease, n (%) | 13 (9.4) | 1 (2.3) | 0.129 |
Diabetes mellitus, n (%) | 9 (6.5) | 4 (9.3) | 0.539 |
Hyperlipidemia, n (%) | 39 (28.3) | 12 (27.9) | 0.964 |
CHA2DS2-VASC Score (SD) | 1.33 (1.26) | 1.65 (1.27) | 0.097 |
Adverse events, n (%) | 10 (7.2) | 4 (9.3) | 0.660 |
Type of adverse events, n (%) | 0.710 | ||
Atrial flutter | 5 (3.6) | 4 (9.3) | |
Bradycardia | 5 (3.6) | 0 (0.0) | |
Torsade de Pointes arrhythmia | 0 (0.0) | 0 (0.0) | |
None | 126 (91.3) | 35 (81.4) | |
QTc-interval pre-cardioversion (ms), (IQR) | 443.0 (421.0–463.0) | 448.5 (421.8–483.5) | 0.380 |
QTc-interval post-cardioversion (ms), (IQR) | 430.5 (406.3–456.8) | 439.0 (414.5–476.3) | 0.292 |
Ibutilide Population | |||
Treatment Success | No Treatment Success | p-value | |
Arterial hypertension, n (%) | 42 (40.8) | 20 (62.5) | 0.032 |
Heart failure, n (%) | 10 (9.7) | 0 (0.0) | 0.068 |
Coronary heart disease, n (%) | 3 (2.9) | 1 (3.1) | 0.951 |
Prior stroke/TIA, n (%) | 8 (7.8) | 1 (3.1) | 0.360 |
Vascular disease, n (%) | 8 (7.8) | 4 (12.5) | 0.413 |
Diabetes mellitus, n (%) | 4 (3.9) | 2 (6.3) | 0.572 |
Hyperlipidemia, n (%) | 17 (16.5) | 9 (28.1) | 0.147 |
CHA2DS2-VASC Score (SD) | 1.39 (1.22) | 1.41 (1.01) | 0.601 |
Adverse events, n (%) | 18 (17.4) | 1 (3.1) | 0.042 |
Type of adverse events, n (%) | 0.037 | ||
Atrial flutter | 4 (3.9) | 1 (3.1) | |
Bradycardia | 13 (12.6) | 0 (0.0) | |
Torsade de Pointes arrhythmia | 1 (1.0) | 0 (0.0) | |
None | 82 (79.6) | 29 (90.6) | |
QTc-interval pre-cardioversion (ms), (IQR) | 455.0 (428.5–472.8) | 456.5 (438.3–488.0) | 0.514 |
QTc-interval post-cardioversion (ms), (IQR) | 466.0 (441.0–497.0) | 500.0 (435.5–518.0) | 0.058 |
Total | Vernakalant | Ibutilide | p-Value | |
---|---|---|---|---|
Cardioversion success, n (%) | 241 (76.3) | 138 (76.2) | 103 (76.3) | 0.991 |
Adverse events, n (%) | 44 (13.9) | 20 (11) | 24 (17.8) | 0.069 |
Type of adverse events, n (%) | 0.059 | |||
Atrial fibrillation | 5 (1.5) | 0 (0.0) | 5 (3.7) | |
Atrial flutter | 9 (2.8) | 9 (5.0) | 0 (0.0) | |
Bradycardia | 18 (5.7) | 5 (2.8) | 13 (9.6) | |
Torsade de Pointes arrhythmia | 1 (0.3) | 0 (0.0) | 1 (0.7) | |
None | 272 (86.1) | 161 (89.0) | 111 (82.2) | |
Cardioversion success in detail, n (%) | 0.213 | |||
No SR | 75 (23.7) | 43 (23.8) | 32 (23.7) | |
SR after 1st application | 165 (52.2) | 102 (56.4) | 63 (46.7) | |
SR after 2nd application | 76 (24.1) | 36 (19.9) | 40 (29.6) | |
CHA2DS2-VASC score (standard deviation) | 1.40 (1.23) | 1.40 (1.27) | 1.39 (1.17) | 0.872 |
QTc-interval pre-cardioversion (ms), (IQR) | 450.0 (424.5–472.0) | 445.0 (421.5–465.5) | 455.5 (434.5–474.5) | 0.061 |
QTc-interval post-cardioversion (ms), (IQR) | 450.5 (421.0–486.0) | 433.5 (408.0–459.3) | 470.5 (441.0–500.3) | 0.001 |
Crude OR (95% CI) | p-Value | * Adjusted OR (95% CI) | p-Value | |
---|---|---|---|---|
Vernakalant | 0.87 (0.61–1.23) | 0.429 | 0.85 (0.58–1.24) | 0.403 |
Ibutilide | 0.62 (0.38–0.94) | 0.024 | 0.55 (0.38–0.92) | 0.022 |
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Lindmayr, T.; Schnaubelt, S.; Sulzgruber, P.; Simon, A.; Niederdoeckl, J.; Cacioppo, F.; Schuetz, N.; Domanovits, H.; Spiel, A.O. Body Weight Counts—Cardioversion with Vernakalant or Ibutilide at the Emergency Department. J. Clin. Med. 2022, 11, 5061. https://doi.org/10.3390/jcm11175061
Lindmayr T, Schnaubelt S, Sulzgruber P, Simon A, Niederdoeckl J, Cacioppo F, Schuetz N, Domanovits H, Spiel AO. Body Weight Counts—Cardioversion with Vernakalant or Ibutilide at the Emergency Department. Journal of Clinical Medicine. 2022; 11(17):5061. https://doi.org/10.3390/jcm11175061
Chicago/Turabian StyleLindmayr, Teresa, Sebastian Schnaubelt, Patrick Sulzgruber, Alexander Simon, Jan Niederdoeckl, Filippo Cacioppo, Nikola Schuetz, Hans Domanovits, and Alexander Oskar Spiel. 2022. "Body Weight Counts—Cardioversion with Vernakalant or Ibutilide at the Emergency Department" Journal of Clinical Medicine 11, no. 17: 5061. https://doi.org/10.3390/jcm11175061
APA StyleLindmayr, T., Schnaubelt, S., Sulzgruber, P., Simon, A., Niederdoeckl, J., Cacioppo, F., Schuetz, N., Domanovits, H., & Spiel, A. O. (2022). Body Weight Counts—Cardioversion with Vernakalant or Ibutilide at the Emergency Department. Journal of Clinical Medicine, 11(17), 5061. https://doi.org/10.3390/jcm11175061