Bayesian network meta- analysis using a r and om-effects model demonstrated that ranolazine + amiodarone intravenous ( IV ) [ odds ratio ( OR ) 39.8 , 95 % credible interval ( CrI ) 8.3 - 203.1 ] , vernakalant ( OR 22.9 , 95 % CrI 3.7 - 146.3 ) , flecainide ( OR 16.9 , 95 % CrI 4.1 - 73.3 ) , amiodarone oral ( OR 10.2 , 95 % CrI 3.1 - 36.0 ) , ibutilide ( OR 7.9 , 95 % CrI 1.2 - 52.5 ) , amiodarone IV ( OR 5.4 , 95 % CrI 2.1 - 14.6 ) , and propafenone ( OR 4.1 , 95 % CrI 1.7 - 10.5 ) were associated with significantly increased likelihood of conversion within 24 h when compared to placebo/control .
Probabilistic analysis ranked vernakalant and flecainide high and propafenone and amiodarone IV low .
For pharmacologic cardioversion of recent-onset AF within 24 h , there is insufficient evidence to determine which treatment is superior .
Vernakalant and flecainide may be relatively more efficacious agents .
Propafenone and IV amiodarone may be relatively less efficacious .
AIMS We sought to identify the most effective antidysrhythmic drug for pharmacologic cardioversion of recent-onset atrial fibrillation ( AF ) .
Early Risks of Death, Stroke/Systemic Embolism, and Major Bleeding in Patients With Newly Diagnosed Atrial Fibrillation: Results From the GARFIELD-AF Registry
Background : Atrial fibrillation is associated with increased risks of death , stroke/systemic embolism , and bleeding ( incurred by antithrombotic therapy ) , which may occur early after diagnosis . Methods : We assessed the risk of early events ( death , stroke/systemic embolism , and major bleeding ) over 12 months and their relation to the time after diagnosis of atrial fibrillation in 52 014 patients prospect ively enrolled in the GARFIELD-AF registry ( Global Anticoagulant Registry in the FIELD – Atrial Fibrillation ) between March 2010 and August 2016 . Results : Over 12 months , 2140 patients died ( mortality rate , 4.3 ; 95 % CI , 4.2–4.5 per 100 person-years ) , of whom 288 ( 13.5 % ) died in the first month ( 6.8 ; 95 % CI , 6.1–7.6 ) . Over 12 months , 657 patients had a stroke/systemic embolism ( 1.3 ; 95 % CI , 1.2–1.4 ) and 411 had a major bleeding ( 0.8 ; 95 % CI , 0.8–0.9 ) . During the first month , the rates ( per 100 person-years ) of stroke/systemic embolism and major bleed were 2.3 ( 95 % CI , 1.9–2.8 ) and 1.5 ( 95 % CI , 1.2–1.9 ) , respectively . The elevated 1-month mortality rate was mostly attributable to cardiovascular mortality ( 3.5 ; 95 % CI , 3.0–4.1 ) , in particular , heart failure , sudden death , and acute coronary syndromes ( 1.0 [ 95 % CI , 0.8–1.4 ] , 0.6 [ 95 % CI , 0.4–0.8 ] , and 0.5 [ 95 % CI , 0.3–0.8 ] , respectively ) . Age , heart failure , prior stroke , history of cirrhosis , vascular disease , moderate-to-severe kidney disease , diabetes mellitus , and living in North or Latin America were independent predictors of a higher risk of early death , whereas anticoagulation and living in Europe or Asia were independent predictors of a lower risk of early death . A predictive model developed for the 1-month risk of death had a C-statistic of 0.81 ( 95 % CI , 0.78–0.83 ) . Conclusions : The increased hazard of early events , in particular , cardiovascular mortality , in newly diagnosed atrial fibrillation points to the importance of comprehensive care for such patients and should alert clinicians to detect warning signs of possible early mortality . Clinical Trial Registration : URL : https://www . clinical trials.gov . Unique identifier : NCT01090362
Bayesian network meta- analysis using a r and om-effects model demonstrated that ranolazine + amiodarone intravenous ( IV ) [ odds ratio ( OR ) 39.8 , 95 % credible interval ( CrI ) 8.3 - 203.1 ] , vernakalant ( OR 22.9 , 95 % CrI 3.7 - 146.3 ) , flecainide ( OR 16.9 , 95 % CrI 4.1 - 73.3 ) , amiodarone oral ( OR 10.2 , 95 % CrI 3.1 - 36.0 ) , ibutilide ( OR 7.9 , 95 % CrI 1.2 - 52.5 ) , amiodarone IV ( OR 5.4 , 95 % CrI 2.1 - 14.6 ) , and propafenone ( OR 4.1 , 95 % CrI 1.7 - 10.5 ) were associated with significantly increased likelihood of conversion within 24 h when compared to placebo/control .
Probabilistic analysis ranked vernakalant and flecainide high and propafenone and amiodarone IV low .
For pharmacologic cardioversion of recent-onset AF within 24 h , there is insufficient evidence to determine which treatment is superior .
Vernakalant and flecainide may be relatively more efficacious agents .
Propafenone and IV amiodarone may be relatively less efficacious .
AIMS We sought to identify the most effective antidysrhythmic drug for pharmacologic cardioversion of recent-onset atrial fibrillation ( AF ) .