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Published on: February 26, 2013
Clinical Efficacy of Canrenone in Restoring Sinus Rhythm in Patients With Atrial Fibrillation-A Pilot, Randomized,
Rafał Dąbrowski1, Agnieszka Segiet-Święcicka1, Stefan Sawicki1
1National Institute of Cardiology, Warsaw, Poland.
Insights
Intravenous potassium canrenoate did not effectively restore sinus rhythm in patients experiencing paroxysmal atrial fibrillation (AF). This study found no significant difference compared to placebo for AF treatment.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Renin-angiotensin-aldosterone system (RAAS) inhibition is a key therapy for atrial fibrillation (AF).
- Potassium canrenoate, an intravenous mineralocorticoid receptor antagonist, is unique among RAAS inhibitors.
- Its efficacy in acute AF episodes requires investigation.
Purpose of the Study:
- To evaluate the clinical effectiveness of intravenous potassium canrenoate for restoring sinus rhythm in patients with paroxysmal AF.
Main Methods:
- A double-center, randomized, double-blind study.
- 52 patients with recent-onset AF (<48h) were randomized to receive intravenous placebo (saline) or canrenone (200 mg).
- The primary endpoint was sinus rhythm restoration within 2 hours.
Main Results:
- Sinus rhythm was restored in 11.5% of placebo patients and 16.0% of canrenone patients (P=.477).
- No significant difference in sinus rhythm restoration was observed between the groups.
- Adverse events were infrequent and similar between placebo and canrenone groups.
Conclusions:
- Intravenous potassium canrenoate is not effective for restoring sinus rhythm in patients with paroxysmal AF.
- Further research may explore alternative applications or patient populations for this agent.
Abstract:
Background and aimsRenin-angiotensin-aldosterone system (RAAS) inhibition is an upstream therapy for managing atrial fibrillation (AF). Of all RAAS-inhibiting agents, only canrenone in the form of potassium canrenoate, a specific inhibitor of mineralocorticoid receptors, is administered intravenously. We evaluated the clinical efficacy of intravenous potassium canrenoate in restoring sinus rhythm in patients with paroxysmal AF episodes.MethodsThis double-center, randomized, double-blind study comprised 52 patients with AF (lasting <48 h) in stable cardiopulmonary conditions who were eligible for cardioversion. The patients were randomly assigned to receive a slow intravenous bolus of 10 ml either as a placebo (0.9% saline) or canrenone (200 mg). The primary endpoint was the return of sinus rhythm within 2 h after drug administration.ResultsOf 52 patients, 27 (51.9%) and 25 (48.1%) were treated with placebo and canrenone, respectively. The median patient age was 68 years, and 27 patients (51.9%) were men. Sinus rhythm restoration during the follow-up period occurred in 3 (11.5%) and 4 (16.0%) patients in the placebo and canrenone arms (P = .477), respectively. Adverse events were observed in 2 (7.4%) and 0 (0.0%) patients in the placebo and canrenone arms, respectively (P = .170).ConclusionsIntravenous canrenone is not effective in the sinus rhythm restoration among the patients with paroxysmal AF.ClinicalTrials.gov. NCT03536806.
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