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 ) .
Safety and efficacy of intravenously administered tedisamil for rapid conversion of recent-onset atrial fibrillation or atrial flutter.
OBJECTIVES The goal of the present study was to assess the efficacy and safety of intravenous tedisamil , a new antiarrhythmic compound , for conversion of recent-onset atrial fibrillation ( AF ) or atrial flutter ( AFL ) to normal sinus rhythm ( NSR ) . BACKGROUND Tedisamil is a novel antiarrhythmic drug with predominantly class III activity . Its efficacy and safety for conversion of recent onset AF or AFL to NSR is not known . METHODS This was a multicenter , double-blind , r and omized , placebo-controlled , sequential ascending dose-group trial . A total of 201 patients with symptomatic AF or AFL of 3 to 48 h duration were enrolled in a two-stage study . During stage 1 , patients were r and omized to receive tedisamil at 0.4 mg/kg body weight or matching placebo ; during stage 2 , patients received tedisamil at 0.6 mg/kg body weight or matching placebo . Treatments were given as single intravenous infusions . The primary study end point consisted of the percentage of patients converting to NSR for at least 60 s within 2.5 h. RESULTS Of 175 patients representing the intention-to-treat sample , conversion to NSR was observed in 41 % ( 25/61 ) of the tedisamil 0.4 mg/kg group , 51 % ( 27 of 53 ) of the tedisamil 0.6 mg/kg group , and 7 % ( 4/59 ) of the placebo group ( p < 0.001 for both tedisamil groups vs. placebo ) . Average time to conversion was 35 min in patients receiving tedisamil . There were two instances of self-terminating ventricular tachycardia : one episode of torsade de pointes and one of monomorphic ventricular tachycardia , both in patients receiving 0.6 mg/kg tedisamil . CONCLUSIONS Tedisamil at dosages of 0.4 and 0.6 mg/kg was superior to placebo in converting AF or AFL . Tedisamil has a rapid onset of action leading to conversion within 30 to 40 min in the majority of responders
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 ) .