allapinin and Atrial-Fibrillation

To assess and compare the safety and efficacy of allapinine and quinidine bisulphate in the treatment of patients with persistent atrial fibrillation after cardioversion. Design--Prospective, randomised, open study. Patients--73 consecutive patients (men only, mean age 44 ± 11 years) with persisnent atrial fibrillation and flutter. Interventions--37 patients were randomised to allapinine (ALP) (1.5 mg/kg/d), 36 to quinidine bisulphate (QUIN) (15 mg/kg/d) with subsequent successful pharmacological or electrical cardioversion. Main outcome measures--Recurrence of atrial fibrillation or side effects.. In the ALP group 15 of the 37 patients developed atrial fibrillation up to 12 month of follow-up, while in the QUIN group 20 patients developed atrial fibrillation and 5 experienced significant side effects. Relative risk (RR) (ALP vs QUIN) 0.58 (95% CI 0.37-0.91, p < 0.02). The number needed to treat (NNT) was (-3.48) (14.2-1.97 harm). When 5 patients with significant side effects were excluded from the analysis RR was 0.62 (95% CI 0.39-1.0, p = 0.052) and NNT--(-4.1) (122.7-2.1 harm) but power of the study was too low--67%.. Allapinine is as effective as quinidine bisulphate in the long term treatment of patients with persistent atrial fibrillation after successful cardioversion but causes significantly less side effects.

Topics: Aconitine; Adult; Anti-Arrhythmia Agents; Atrial Fibrillation; Drug Monitoring; Electric Countershock; Humans; Male; Middle Aged; Quinidine; Recurrence; Time; Treatment Outcome

Echocardiographic study was performed in 24 patients with persistent atrial fibrillation (PAF) without clinical signs of circulatory failure. When treated with allapinin , all the patients with PAF showed a significant increase in heart rate (HR) and cardiac output (CO) and a decrease in total peripheral vascular resistance (TPVR). No substantial changes in the major hemodynamic parameters were found in patients with higher left ventricular dimensions; however, a significant rise in end systolic volume (ESV) was noted. There was significantly lower HR, diminished ESV, higher stroke volume and increased CO, elevated ejection fraction and TPVR with sinus rhythm. In PAF patients without apparent signs of circulatory failure, hemodynamic effects of allapinin may be accounted for by its direct vasodilatory action on the arterial bed and by its ability to affect cardiac autonomic innervation. A moderate cardiodepressive effect of the agent may be reflected by deteriorated latent signs of myocardial incompetence which are levelled off following sinus rhythm recovery.

Topics: Aconitine; Aconitum; Adult; Anti-Arrhythmia Agents; Atrial Fibrillation; Chronic Disease; Clinical Trials as Topic; Hemodynamics; Humans; Male; Middle Aged; Sinoatrial Node; Stimulation, Chemical; Tablets

Lappaconitine Hydrobromide (LH, allapinin) has been included by authors of National Guidelines on Diagnosis and Treatment of Atrial Fibrillation (AF), 2012 in the number of medications recommended for use in patients with AF for rhythm control. Moreover, LH is also included into the List of Vital and Essential Medicinal Drugs (VEMD) 2015. However, LH is not mentioned in corresponding guidelines of the European Society of Cardiology (ESC). Aim of the present review was to explore evidence base underlining use of LH in the context of AF and to understand reason for LH-related discrepancy between European and domestic guidelines.. Literature search has indicated that efficacy of LH was assessed only in small open studies. None of prospective trials included more than 100 patients. For more than 25 years of presence on the market slightly more than 400 patients were administered LH in clinical studies. In the only trial, designated as randomized number of participants (only men younger than 60 years) was small and the comparator was quinidine that presently is not used for maintenance of sinus rhythm in AF. Another study referenced in domestic guidelines on management of AF was observational and not intended for comparison of antiarrhythmic activity of drugs.. Design of studies reviewed as well as their results provide insufficient evidence supporting the use of LH for maintenance of sinus rhythm in routine management of AF. At present inclusion of LH in guidelines on AF management and in the List of VEMD appears unjustified.

Topics: Aconitine; Anti-Arrhythmia Agents; Atrial Fibrillation; Evidence-Based Practice; Humans; Male; Prospective Studies

Topics: Aconitine; Animals; Anti-Arrhythmia Agents; Atrial Fibrillation; Cats; Electric Stimulation; Electrocardiography; Periodicity; Vagus Nerve

In atrial fibrillation, allapinine was shown to enhance rhythm by 7% and to increase cardiac output (p less than 0.05), as well as to slightly lower mean blood pressure and peripheral vascular resistance at rest. With exercise, both in atrial fibrillation, and sinus rhythm, there was a decrease in end-diastolic and end-systolic volumes of the left ventricle (p less than 0.05), a slight drop in ventricular ejection, that was statistically significant only with sinus rhythm (p less than 0.05). Physical exercise was not followed by an apparent additional aggravation of myocardial contractility, which makes allapinine preferable for long-term application to preserve sinus rhythm in patients without evident signs of heart failure.

Topics: Aconitine; Adolescent; Adult; Anti-Arrhythmia Agents; Atrial Fibrillation; Echocardiography; Exercise Test; Hemodynamics; Humans; Male; Middle Aged

The cardiorespiratory system was studied comprehensively in 27 patients with permanent atrial fibrillation (PAF) without the clinically marked signs of circulatory failure. After allapinine treatment 15 patients with bronchial obstruction manifestations demonstrated, in the presence of lasting PAF, a significant increase of the forced expiration capacity per s and of the maximum volumetric expiration rates. The data obtained may attest to the fact that the drug has beta-stimulating properties, confirming the reported evidence.

Topics: Aconitine; Adult; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Bronchodilator Agents; Cardiovascular Diseases; Chronic Disease; Humans; Male; Middle Aged; Respiration; Respiratory Function Tests