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 ) .
Benefits of Rhythm Control and Rate Control in Recent-onset Atrial Fibrillation: The HERMES-AF Study.
BACKGROUND Although rhythm control has failed to demonstrate long-term benefits over rate control in longst and ing episodes of atrial fibrillation ( AF ) , there is little evidence concerning recent-onset ones . We analyzed the benefits of rhythm and rate control in terms of symptoms alleviation and need for hospital admission in patients with recent-onset AF . METHODS This was a multicenter , observational , cross-sectional study with prospect i ve st and ardized data collection carried out in 124 emergency departments ( EDs ) . Clinical variables , treatment effectiveness , and outcomes ( control of symptoms , final disposition ) were analyzed in stable patients with recent-onset AF consulting for AF-related symptoms . RESULTS Of 421 patients included , rhythm control was chosen in 352 patients ( 83.6 % ) , a global effectiveness of 84 % . Rate control was performed in 69 patients ( 16.4 % ) and was achieved in 67 ( 97 % ) of them . Control of symptoms was achieved in 396 ( 94.1 % ) patients and was associated with a heart rate after treatment ≤ 110 beats/min ( odds ratio [ OR ] = 14.346 , 95 % confidence interval [ CI ] = 3.90 to 52.70 , p < 0.001 ) and a rhythm control strategy ( OR = 2.78 , 95 % CI = 1.02 to 7.61 , p = 0.046 ) . Sixty patients ( 14.2 % ) were admitted : discharge was associated with a rhythm control strategy ( OR = 2.22 , 95 % CI = 1.20 - 4.60 , p = 0.031 ) and admission was associated with a heart rate > 110 beats/min after treatment ( OR = 29.71 , 95 % CI = 7.19 to 123.07 , p < 0.001 ) and acute heart failure ( OR = 9.45 , 95 % CI = 2.91 to 30.65 , p < 0.001 ) . CONCLUSION In our study , recent-onset AF patients in whom rhythm control was attempted in the ED had a high rate of symptoms ' alleviation and a reduced rate of hospital admissions
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 ) .