Antiarrhythmic therapy choice in patients with left ventricular diastolic dysfunction and atrial fibrillation

Abstract

Aim. To study clinical effectiveness, safety, and effects on left ventricular (LV) systolic and diastolic function for Class IC and Class III antiarrhythmic medications — propafenone and amiodarone, respectively — in patients with chronic heart failure (CHF), intact ejection fraction (EF), and atrial fibrillation (AF).
Material and methods. Out of 227 patients, 198 were followed for 12 months (mean age 54,4±2,1 years). For AF prevention, 138 and 60 participants received propafenone and amiodarone, respectively. The assessed parameters included AF episode incidence, their duration, LV systolic and diastolic function, and therapy safety (incidence of adverse effects, AE) in CHF with intact LV EF.
Results. After 12 months of the treatment, propafenone and amiodarone effectiveness for AF prevention was similar — 61,4 % and 63,2 %, respectively. ImprovedLV diastolic filling was associated with increased numbers of Functional Class I CHF patients (+50 %) and reduced hospitalization rates (-72,9). In CHF patients with intact LV EF, propafenone demonstrated a better safety profile than amiodarone: AE incidence was 0,72 % vs. 31,8 %, respectively.

Conclusion. In CHF patients with intact LV EF and paroxysmal and/or persistent AF, the Class IC antiarrhythmic medication propafenone demonstrated high antiarrhythmic effectiveness, safety, and beneficial effects onLV diastolic function.