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 ) .
Comparison of sotalol with digoxin-quinidine for conversion of acute atrial fibrillation to sinus rhythm (the Sotalol-Digoxin-Quinidine Trial).
We r and omized 61 patients with paroxysmal atrial fibrillation ( AF ) ( < 48 hours from onset ) to either sotalol or quinidine treatment .  Conversion of rhythm was recorded by Holter monitoring . The starting 80 mg dose of sotalol was repeated at 2 , 6 , and 10 hours if AF persisted ( heart rate > 80 beats/min ) , and if systolic blood was > or = 120 mm Hg . In the quinidine group , if heart rate > 100 beats/min , it was decreased with intravenous digoxin , whereafter 200 mg of oral quinidine sulfate was given maximally 3 times , each dose 2 hours apart . Conversion of AF to sinus rhythm occurred in 17 or 33 patients ( 52 % ) taking sotalol , and in 24 of 28 patients ( 86 % ) taking quinidine ( p < 0.0001 ) . Electric cardioversion was necessary in 39 % of the former and in 14 % of the latter group . The mean delay from first trial drug to sinus rhythm with the trial medication was 10.2 + /- 7.6 hours in the sotalol group and 4.0 + /- 2.9 hours in the quinidine group ( p < 0.01 ) . Treatment was discontinued in 16 patients taking sotalol ( 48 % ) because of asymptomatic bradycardia or hypotension , and in 20 taking quinidine ( 71 % ) because of rhythm conversion . Asymptomatic wide complex tachycardia ( QRS > 0.12 second ) was found in 13 % and 27 % of patients taking sotalol and quinidine , respectively . The longest RR intervals were 6.4 and 3.8 seconds in the sotalol and quinidine groups , respectively . Oral sotalol did not appear as effective as quinidine sulfate treatment in conversion of paroxysmal AF . ( ABSTRACT TRUNCATED AT 250 WORDS
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 ) .