Comparative effectiveness of propafenone and aksaritmin for conversion of paroxysmal atrial fibrillation
Authors: Kuchkarov H , Zakirov N , Kurbanov R , Kabilova D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Aksaritmin (the sum of nine deterpenoid alkaloids, including lappaconitini hydrobromidum) is an antiarrhythmic drug (conditionally belongs to the I C class) which is extracted from the roots and rhizomes of local plant - Aconitum septentrionale (tablet 25 mg).

Purpose
Evaluation of comparative effectiveness of propafenone (Pr) and aksaritmin (Aks) for conversion of atrial fibrillation (AF) in patients without/minimal structural heart disease (ejection fraction is more than 50%).

Materials and methods
The study included 60 patients (31 men), mean age - 55.3±11.9 y.o. The inclusion criteria for patients in the study were: hemodynamically stable symptomatic paroxysmal AF (mean duration–16.3±9.1 hours). On the day of admission, all patients underwent a test of the necessary biochemical blood parameters, electrocardiography, 24-hour ECG monitoring, transthoracic echocardiography. The patients were divided into two groups (they did not differ in the main clinical and anamnestic characteristics): 1-group (n=30), Pr was prescribed in dose 450-600 mg per os; 2-group (n=30), Aks was prescribed in dose 50 mg (in combination with beta-blockers (60%) in cases of tachysystole (≥ 140 b.p.m.)) per os. Statistical analysis was carried out by the STATISTICA 13.

Results
The main causes of AF in group 1 and group 2: hypertension - 17 (56.7%) and 16 (53.3%), chronic persistent myocarditis - 11 (36.7%) and 12 (40%), idiopathic AF - 2 (6.7%) and 2 (6.7%) patients, respectively. The anamnesis of AF averaged 17.3±3.8 months in gr 1 and 18.2±4.7 months in gr 2. Pr according to the above-described scheme ("pill in a pocket"), sinus rhythm was restored in 22 (73.3%) of 30 patients, and the mean time to restore the sinus rhythm was 4.12±3.87 hours from the start of therapy. At the same time, the effectiveness of Pr in patients with a paroxysm duration of less than 24 hours was 77.2% - in 17 patients out of 22, with a duration 24-48 hours it was 62.5% - 5 patients out of 8. Aks restored sinus rhythm in 21 (70%) out of 30 patients (χ2=0.082; p&gt;0.05), and the mean restoring time of sinus rhythm was 4.63±4.33 hours from the start of therapy (p&gt;0.05). At the same time, the effectiveness of Aks in patients with a paroxysm duration of less than 24 hours was 81.8% - in 18 patients out of 22 (χ2=0.140; p&gt;0.05), with a duration of more than 24-48 hours it was 37.5%-3 patients out of 8 (χ2=1.000; p&gt;0.05).

Conclusion
Pr and Aks practically did not differ in efficiency (73.3% and 70%, respectively) and in the time of relief (4.12±3.87 h and 4.63±4.33 h, respectively) of AF paroxysms. At the same time, Aks (including combination with beta-blockers) was more preferable for relief of AF with a duration of up to 24 hours-81.8% versus 77.2% (p&gt;0.05), and propafenone for relief of AF with a duration of more than 24-48 hours-62.5% versus 37.5% (p&gt;0.05). Aks is relatively new and promising drug for the treatment of patients with new onset paroxysmal AF.