ΑΝΤΙΑΡΡΥΘΜΙΚΑ ΦΑΡΜΑΚΑ ΓΙΑ ΠΡΟΛΗΨΗ ΥΠΟΤΡΟΠΩΝ ΚΟΛΠΙΚΗΣ ΜΑΡΜΑΡΥΓΗΣ Τι νεότερο? ΠΑΝΑΓΙΩΤΗΣ ΚΟΡΑΝΤΖΟΠΟΥΛΟΣ Επίκουρος Καθηγητής Καρδιολογίας Α Καρδιολογική Κλινική Παν. Ιωαννίνων
Basic mechanisms underlying AF-related remodelling and therapy Nattel S et al. Eur Heart J 2014;35:1448-1456 Published on behalf of the European Society of Cardiology. All rights reserved. The Author 2014. For permissions please email: journals.permissions@oup.com.
Copyright 2015 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
PACE 2013; 36:122 133
Circ Res 2014;114:1532-1546.
Circ Res. 2014;114:1532-1546.
Hypothesis Non-hypoxic cardiac preconditioning Moderate ROS levels enhance endogenous antioxidant response / Activation of Nrf2 transcription factor N-3 fatty acids increase myocardial ROS
N-3 PUFAs 2gr/d 7 days before surgery until hospital discharge (1:2 EPA:DHA ratio) Vitamin C (1 g/d) plus vitamin E (400 IU/d) 2 days before surgery until hospital discharge 100 pts placebo, 32% POAF 103 pts supplemented, 9.7% POAF Rodrigo R, Korantzopoulos P, Cereceda M, et al. JACC 2013
Pacing Clin Electrophysiol. 2014 Oct;37(10):1412-20.
Am J Cardiol;2011:108:673-6
A+R 88% conversion rate / time to conversion 9.8±4.1 hours A 65% conversion rate / time to conversion 14.6±5.3 hours Am J Cardiol 2012;110:673-7.
121 patients were randomized in a 1 : 1 ratio to either intravenous amiodarone (60 min loading dose of 5 mg/kg followed by maintenance infusion of 50 mg/h until conversion to SR, for a maximum of 24 h) or intravenous amiodarone at the same dosage and duration plus oral ranolazine 1500 mg given once at the time of randomization.
Rate of conversion of AF to SR at 24 h (A) and at 12 h (B) in patients treated with amiodarone plus ranolazine or with amiodarone alone Koskinas K C et al. Europace 2014;16:973-979 Published on behalf of the European Society of Cardiology. All rights reserved. The Author 2014. For permissions please email: journals.permissions@oup.com.
Time to conversion of AF to SR in patients treated with amiodarone plus ranolazine or with amiodarone alone Koskinas K C et al. Europace 2014;16:973-979 Published on behalf of the European Society of Cardiology. All rights reserved. The Author 2014. For permissions please email: journals.permissions@oup.com.
Conversion rate of AF to SR at 24 h in patients stratified according to LA diameter by TTE < 46 mm (left) vs. 46 mm (right) and according to treatment with amiodarone plus ranolazine (Amio and Ran) vs. amiodarone alone (Amio). Koskinas K C et al. Europace 2014;16:973-979 Published on behalf of the European Society of Cardiology. All rights reserved. The Author 2014. For permissions please email: journals.permissions@oup.com.
25 pts with unsuccessful ECV 2gr Ranolazine, 2nd attempt 3.5-4 h later 76% success rate PACE 2012;35(3):302-7.
This prospective,multicenter, randomized,double-blind, placebo-control parallel group phase II dose-ranging trial randomized patients with persistent AF (7days to 6months) 2 hours after successful electrical cardioversion to placebo,or ranolazine 375mg, 500mg, or 750 mg bid.patients were monitored daily by transtelephonic ECG.The primary endpoint was the time to first AF recurrence. AF recurred in 56.4%, 56.9%, 41.7%, and 39.7% of patients in the placebo, ranolazine 375 mg, ranolazine 500mg, and ranolazine 750mg groups, respectively.the reduction in overall AF recurrence in the combined 500-mg and 750-mg groups was of borderline significance compared to the placebo group (P 0.053) and significant compared to 375-mg group (P 0.035). Heart Rhythm 2015;12:872 878
Heart Rhythm 2015;12:872 878
Figure 2. Kaplan Meier recurrence-free survival curves comparing the 500 mg +750 mg combined group with placebo (n = 173) (A) and for the prespecified population of patients who were still in sinus rhythm after 48 hours (n = 157) (B). Heart Rhythm, Volume 12, Issue 5, 2015, 872 878 http://dx.doi.org/10.1016/j.hrthm.2015.01.021
We hypothesized that moderate dose ranolazine combined with reduced dose dronedarone would be superior to individual drug therapy in suppressing AF HARMONY was a randomized, double-blind, placebo-controlled, parallel-group study HARMONY enrolled patients with both (1) paroxysmal AF (PAF) and (2) dual-chamber programmable pacemakers implanted for standard clinical indications F/U 12 weeks Circ Arrhythm Electrophysiol. 2015 Jul 30. pii: CIRCEP.115.002856. [Epub ahead of print]
Ο ΡΟΛΟΣ ΤΗΣ ΚΟΛΧΙΚΙΝΗΣ ΣΤΗΝ ΚΟΛΠΙΚΗ ΜΑΡΜΑΡΥΓΗ F/U 3 months
AF recurrence rate in the colchicine group was 31.1% (32/103) vs 49.5% (51/103) in the control group
Colchicine for prevention of atrial fibrillation recurrence after pulmonary vein isolation: Mid-term efficacy and effect on quality of life Figure 4 Increases in health-related quality-of-life (QoL) scores per treatment group. Figures correspond to absolute changes at 3 and 12 months (mean value of these changes indicated on top of the bars) compared to baseline, using analysis of covariance... Heart Rhythm, Volume 11, Issue 4, 2014, 620-628 http://dx.doi.org/10.1016/j.hrthm.2014.02.002
The COPPS POAF substudy included 336 patients (mean age, 65.712.3 years; 69% male) of the COPPS trial, a multicenter, double-blind, randomized trial. Substudy patients were in sinus rhythm before starting the intervention (placebo/colchicine 1.0 mg twice daily starting on postoperative day 3 followed by a maintenance dose of 0.5 mg twice daily for 1 month in patients 70 kg, halved doses for patients 70 kg or intolerant to the highest dose). Reduced incidence of POAF (12.0% versus 22.0%, respectively; P=0.021; relative risk reduction, 45%; number needed to treat, 11) with a shorter in-hospital stay (9.43.7 versus 10.34.3 days; P=0.040) and rehabilitation stay (12.16.1 versus 13.96.5 days; P=0.009).
Patients were randomized to receive placebo (n=180) or colchicine (0.5mg twice daily in patients70 kg or 0.5mg once daily in patients <70 kg; n=180) starting between 48 and 72 hours before surgery and continued for 1 month after surgery.
ΠΑΡΑΤΗΡΗΣΕΙΣ- ΣΥΜΠΕΡΑΣΜΑΤΑ Τα υποστρώματα της ΚΜ είναι πολλά και διαφορετικά Δεν φαίνεται να υπάρχει αμιγώς ηλεκτροφυσιολογικό υπόστρωμα Ύπαρξη SECOND FACTOR - Δομική και αυτόνομη αναδιαμόρφωση Πολυπαραγοντική αντιμετώπιση Συνοσηρότητες Επεμβατική αντιμετώπιση PVI Ganglionic plexi σε πρώιμο στάδιο αναδιαμόρφωσης Φάρμακα (κλασσικά ή μη κλασσικά αντιαρρυθμικά - συνδυασμοί) Υποσχόμενοι παράγοντες η ρανολαζίνη και η κολχικίνη. Διευκρίνιση του ρόλου τους στην στρατηγική ελέγχου ρυθμού μακροχρόνια πρόληψη υποτροπών AF και στη συγχορήγηση με κλασσικά αντιαρρυθμικά.