Personalized selection in the treatment of paroxysmal atrial fibrillation and atrial flutter in elderly patients (refralone or amiodarone)

Abstract

Atrial fibrillation (AF) and atrial flutter (AFL) remain the most common forms of cardiac rhythm disturbances in elderly patients, leading to important considerations regarding the management of this patient population, particularly concerning paroxysmal forms of AF and AFL: the selection of effective and safe antiarrhythmic agents for the termination of paroxysms. The objective of the study, under the principle of patient- centered care, was to conduct a comparative analysis of the effectiveness and safety of Refralone and Amiodarone in elderly patients with paroxysmal AF /AFL. Materials and methods. The study involved 58 patients aged 65 years and older with stable hemodynamics and preserved cognitive function, who underwent pharmacological cardioversion for paroxysms of AF or AFL with an attempt to restore sinus rhythm (SR) using Refralone (31 patients) and Amiodarone (27 patients), assessing the clinical, ECG effectiveness, and safety of these medications. Results. The study findings demonstrated a high effectiveness of Refralone in terminating paroxysms of AF /AFL in elderly patients, achieving a success rate of 100% compared to 77.7% for Amiodarone (p<0.05), with the use of lower doses and less time required to restore SR. Refralone also showed advantages in safety: it did not provoke bradyarrhythmias or hypotension, whereas these adverse effects were observed with Amiodarone. Furthermore, episodes of hypoglycemia were recorded in elderly patients with type 2 diabetes when treated with Amiodarone. Both drugs proved to be safe concerning ventricular activity.