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 ) .
Ranolazine Added to Amiodarone Facilitates Earlier Conversion of Atrial Fibrillation Compared to Amiodarone‐Only Therapy
Background : Amiodarone ( AMIO ) is for many years effectively used to control ventricular rate during atrial fibrillation ( AF ) and to convert it into sinus rhythm . However , due to its delayed onset of action , ranolazine ( RAN ) , a new antianginal agent with atrial‐selective electrophysiologic properties , has recently been attempted as add‐on therapy with AMIO to facilitate AF conversion . Methods : To establish the role of this combination therapy , we enrolled 173 consecutive patients ( 68 ± 10 years , 54 % male ) with recent‐onset ( < 48‐hour duration ) AF who were eligible for pharmacologic cardioversion . Patients were r and omized to intravenous AMIO ( loading dose 5 mg/kg in 1 hour followed by 50 mg/h ; n = 81 ) , or AMIO plus a single oral dose of RAN 1 g ( n = 92 ) . Results : Mean left atrial diameter did not significantly differ between groups , AMIO and AMIO + RAN ( 4.2 ± 0.5 cm vs 4.1 ± 0.4 cm , P = 0.18 ) . The AMIO + RAN group compared with the AMIO‐only group showed significantly shorter time to conversion ( 8.6 ± 2.8 hours vs 19.4 ± 4.4 hours , P < 0.0001 ) and higher conversion rate at 24 hours ( 98 % vs 58 % , P < 0.001 ) . Left ventricular ejection fraction did not markedly vary between the two groups and ranged within moderately reduced values . No serious clinical ly evident adverse effects were observed in any of the patients receiving either AMIO or the combination treatment . Conclusions : Our data demonstrate faster sinus rhythm restoration and enhanced conversion rate of AF  after AMIO plus RAN in patients with preserved ejection fraction and left atrial size , implicating a synergistic effect of the two agents
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 ) .