Sulcardine administration for treatment of acute atrial fibrillation

1. A method of treating atrial fibrillation (AF) or atrial flutter in a patient, comprising administering to the patient a pharmaceutical composition comprising sulcardine or a pharmaceutically acceptable salt thereof, wherein administering the pharmaceutical composition to the patient produces in the patient a change in one or more ECG parameters, wherein the one or more ECG parameters increase by no more than about 25%, further wherein the one or more ECG parameters comprise QRS, PDur, PR, or QTcF, or any combination thereof.

2. The method of claim 1 , wherein the ECG parameters further comprise a decrease in JTpc by no more than about 25 msec; and no change in TpTe.

3. The method of claim 1 , wherein the ECG parameters further comprise an increases in heart rate (HR) of no more than about 25%; or wherein the ECG parameters further comprise an increase in HR that is not clinically significant.

4. The method of claim 3 , wherein the maximum ECG parameter change occurs prior to or at about Tmax.

5. The method of claim 1 , wherein the method inhibits early after depolarization.

6. The method of claims 1 , wherein the method increases or decreases diastolic and/or systolic blood pressure by no more than about 25%.

7. The method of claims 1 , wherein the method does not induce a 2 nd or 3 rd degree heart block.

8. The method of claims 1 , wherein sulcardine, or a pharmaceutically acceptable salt thereof, is administered at a dose of 200 mg, 350 mg, 500 mg, or 600 mg.

9. The method of claims 1 , wherein the pharmaceutically acceptable salt is ethane-1,2-disulfonic acid, naphthalene-1,5-disulfonic acid, 1-hydroxy-2-naphthoic acid, naphthalene-2-sulfonic acid, dihydro sulfonic acid, hydrochloric acid, or hydrobromic acid.

10. The method of claim 1 , wherein the QT and/or QRS intervals increases by about 5% to about 20% after the administration of the composition.

11. The method of claim 1 , wherein a mean average plasma profile characterized by a Cmax after administering 200 mg of the compound, of at least about 1,500 ng/mL at about Tmax, and at most 25% of Cmax at about 1.0 hours after administration.

12. The method of claims 1 , wherein the composition produces a mean average plasma profile characterized by a Cmax after administering 350 mg of the compound, of at least about 3,000 ng/mL at about Tmax, and at most 25% of Cmax at about 1.0 hours after administration.

13. The method claims 1 , wherein the composition produces a mean average plasma profile characterized by a Cmax after administering 500 mg of the compound, of at least about 4,000 ng/mL at about Tmax, and at most 25% of Cmax at about 1.0 hours after administration.

14. The method of claims 1 , wherein the composition produces a mean plasma profile characterized by an average Cmax after administering 600 mg of the compound, of at least about 5,500 ng/mL at about Tmax, and at most 25% of Cmax at about 1.0 hours after administration.

15. The method of claim 1 , wherein administering the pharmaceutical composition to the patient results in a decrease in plasma concentration of at least about 75% within about 1 hour after administration.

16. The method of claims 1 , wherein the administration comprises intravenous injection, intramuscular injection, intraperitoneal injections, subcutaneous injection, or oral consumption.

17. The method of claims 1 , wherein sulcardine, or a pharmaceutically acceptable salt thereof, is administered over a period less than about 1 hour.

18. The method of claim 17 , wherein sulcardine, or a pharmaceutically acceptable salt thereof, is administered over a period of about 30 minutes.

19. The method of claim 17 , wherein sulcardine, or a pharmaceutically acceptable salt thereof, is administered over a period of about 15 minutes.

20. The method of claim 1 , wherein sulcardine, or a pharmaceutically acceptable salt thereof, is administered at a rate that does not produce an arrhythmia or a clinically significant change in heart rate or blood pressure.

21. The method of claim 1 , wherein the AF is acute AF, paroxysmal AF, recurring AF or wherein the treatment is for atrial flutter.

22. The method of claim 1 , wherein the method inhibits late sodium channels, fast sodium channels, L-type calcium channels in the heart, or a combination thereof, in the patient.

23. The method of claim 1 , wherein a bimodal effect on QTc can occur including prolongation in QTc at lower drug exposure levels (doses) in association with INa cardiac ion channel inhibition followed by a potential plateauing or decrease in QTc interval at higher drug exposure levels (doses) associated with increasing inhibitory effect on NaL and ICa cardiac ion channels.

24. The method of claim 1 , wherein the composition results in inhibition of early after depolarizations (EADs).

25. The method of claim 1 , wherein an attenuation in prolongation or a shortening in QTc follows an increase in QTc interval.

26. The method of claim 1 , wherein the composition is administered to a subject in need by parenteral administration, intravenous infusion or oral consumption.

27. The method of claim 1 , wherein the composition produces a mean average plasma profile characterized by a Cmax after administering 350 mg of the compound, of at least about 3,000 ng/mL at about 0.5 hours after administration, and at most 25% of Cmax at about 1.0 hours after administration.

28. The method of claim 1 , wherein the composition produces a mean average plasma profile characterized by a Cmax after administering 500 mg of the compound, of at least about 4,000 ng/mL at about 0.5 hours after administration, and at most 25% of Cmax at about 1.0 hours after administration.

29. The method of claim 1 , wherein the composition produces a mean average plasma profile characterized by a Cmax after administering 600 mg of the compound, of at least about 5,500 ng/mL at about 0.5 hours after administration, and at most 25% of Cmax at about 1.0 hours after administration.

30. The method of claim 1 , wherein the composition produces a mean average plasma profile characterized by an AUC after administering 200 mg of the compound, of at least about 1,200 ng·h/mL at about 0.5 hours after administration.

31. The method of claim 1 , wherein the composition produces a mean average plasma profile characterized by an AUC after administering 350 mg of the compound, of at least about 2,800 ng·h/mL at about 0.5 hours after administration.

32. The method of claim 1 , wherein the composition produces a mean average plasma profile characterized by an AUC after administering 500 mg of the compound, of at least about 4,000 ng·h/mL at about 0.5 hours after administration.

33. The method of claim 1 , wherein the composition produces a mean average plasma profile characterized by an AUC after administering 200 mg of the compound, of at least about 5,200 ng·h/mL at about 0.5 hours after administration.

34. A method of treating atrial fibrillation (AF) or atrial flutter in a human subject, comprising administering to the human subject in need thereof an amount of sulcardine, or a pharmaceutically acceptable salt thereof, wherein amount of sulcardine, or pharmaceutically acceptable salt thereof, is sufficient to achieve a Tmax of plasma concentration of sulcardine, or a pharmaceutically acceptable salt thereof, in the human subject in about less than 2.0 hours.

35. The method of claim 34 , wherein the administration results in:

(i) an increase of less than about 25% in QRS, PDur, PR, and QTcF;

(iii) a reduction of less than 10% in JTp; and

(iii) no effect or increase in TpTe.

36. The method of claim 34 , wherein the pharmaceutically acceptable salt is ethane-1,2-disulfonic acid, naphthalene-1,5-disulfonic acid, 1-hydroxy-2-naphthoic acid, naphthalene-2-sulfonic acid, hydrochloric acid, or hydrobromic acid.

37. The method of claims 34 , wherein the sulcardine, or a pharmaceutically acceptable salt thereof is administered to a subject in need by intravenous injection, intraperitoneal injection, or oral consumption.

38. The method of claim 34 , wherein the method produces a change in QTc interval that does not increase by more than about 20% after administration.

39. The method of claims 34 , wherein the method produces an increased in QTc interval from about 5% to about 20% after administration.

40. The method of claims 34 , wherein the sulcardine, or a pharmaceutically acceptable salt thereof is administered over a period of less than about 1 hour.

41. The method of claim 40 , wherein the sulcardine, or a pharmaceutically acceptable salt thereof, is administered over a period of about 30 minutes.

42. The method of claim 40 , wherein the sulcardine, or a pharmaceutically acceptable salt thereof, is administered at a rate that does not produce an arrhythmia or a clinically significant change in heart rate of blood pressure.

43. The method of claim 34 , wherein the sulcardine, or a pharmaceutically acceptable salt thereof is administered after less than 7 days after the onset of symptoms without need for anticoagulation.

44. The method of claim 34 , wherein the sulcardine, or a pharmaceutically acceptable salt thereof is administered no more than 72 hours after the onset of symptoms.

45. The method of claim 34 , wherein the AF is acute AF.