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 intravenous flecainide, propafenone, and amiodarone for conversion of acute atrial fibrillation to sinus rhythm.
In a prospect i ve , single-blind trial , we r and omized 150 consecutive symptomatic patients with acute ( < or = 48 hours ' duration ) atrial fibrillation to receive intravenous flecainide , propafenone , or amiodarone . Flecainide and propafenone were administered as a bolus dose of 2 mg/kg in 20 minutes . A second bolus dose of 1 mg/kg in 20 minutes was administered if conversion to sinus rhythm was not achieved after 8 hours . Amiodarone was administered as a bolus of 5 mg/kg in 20 minutes followed by a continuous infusion of 50 mg/hour . By the end of a 12-hour observation period , conversion to sinus rhythm was achieved in 45 patients ( 90 % ) in the flecainide group , 36 ( 72 % ) in the propafenone group , and 32 ( 64 % ) in the amiodarone group ( p = 0.008 for the overall comparison , p = 0.002 for flecainide vs amiodarone , p = 0.022 for flecainide vs propafenone , and p = 0.39 for propafenone vs amiodarone ) . When compared with amiodarone , this higher reversion rate with flecainide was present from the first hour of the study period . However , only after administering the second bolus was there a significant difference between flecainide and propafenone .  Median time to conversion to sinus rhythm was different among groups ( p < 0.001 ) , and it was lower in the flecainide ( 25 minutes ; range 4 to 660 ) and propafenone ( 30 minutes ; range 10 to 660 ) groups than in the amiodarone group ( 333 minutes ; range 15 to 710 ; p < 0.001 for both comparisons ) . Flecainide , at the doses administered in this study , is more effective than propafenone and amiodarone for conversion of acute atrial fibrillation to sinus rhythm .  Propafenone and amiodarone have similar conversion rates , although propafenone was faster in achieving the conversion to sinus rhythm
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 ) .