Inclusion criteria | |
• Written informed consent for enrollment | |
• Patients aged between 40 and 75 years | |
• Atrial fibrillation episode lasting for less than 48 h, documented by the ECG | |
• Potassium plasma level < 4.5 mmol/l | |
• Systolic blood pressure > 120 mmHg | |
• Stable cardiopulmonary status (according to attending physician’s assessment) | |
• In the case of left ventricle injury suspicion or unclear medical history of cardiac insufficiency, enrollment will be possible after echocardiographic examination | |
Exclusion criteria | |
• No written informed consent for enrollment | |
• Allergy to canrenone or spironolactone | |
• Cardiac insufficiency or left ventricular ejection fraction < 40% | |
• Systolic blood pressure ≤ 120 mmHg | |
• History of canrenone treatment in the 30 days before enrollment | |
• Average QRS rate > 160 per minute | |
• Advanced hepatic (international normalized ratio > 1.5, aminotransferases > 3 times above normal) or renal failure (eGFR < 40 ml/min/1.73 m2) | |
• History of acute coronary syndrome, coronary artery bypass grafting, transient ischemic attack or stroke within the previous 30 days | |
• Pre-excitation syndrome (which has not been treated with accessory pathway ablation) | |
• Atrial fibrillation due to valvular heart disease | |
• Atrial fibrillation episode resulting in myocardial ischemia (chest pain, ischemic changes in the ECG) | |
Antiarrhythmic agents | |
• Rate control medications, such as β-blockers or calcium channel blockers (verapamil, diltiazem), are allowed in the preceding 2 h | |
• Chronic antiarrhythmic therapy is not an exclusion criterion. Atrial fibrillation episode indicates for its low efficacy |