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 ) .
Vernakalant is superior to ibutilide for achieving sinus rhythm in patients with recent-onset atrial fibrillation: a randomized controlled trial at the emergency department
Aims Ibutilide is a rapid‐acting antiarrhythmic drug with worldwide use for conversion of recent‐onset atrial fibrillation . Vernakalant , approved in the EU in 2010 , is likewise used intravenously , with proven efficacy and safety compared with placebo and amiodarone in r and omized clinical trials . The aim of our study was to compare the time to conversion and the conversion rate within 90 min in patients with recent‐onset atrial fibrillation treated with vernakalant or ibutilide .  Methods and results A r and omized controlled trial registered at clinical trials.gov ( NCT01447862 ) was performed in 100 patients with recent‐onset atrial fibrillation treated at the emergency department of a tertiary care hospital . Patients received up to two short infusions of vernakalant ( n = 49 ; 3 mg/kg followed by 2 mg/kg if necessary ) or ibutilide ( n = 51 ; 1 mg followed by another 1 mg if necessary ) according to the manufacturer 's instructions . Clinical and laboratory variables , adverse events , conversion rates , and time to conversion were recorded . Time to conversion of AF to sinus rhythm was significantly shorter in the vernakalant group compared with the ibutilide group ( median time : 10 vs. 26 min , P = 0.01 ) , and likewise the conversion success within 90 min was significantly higher in the vernakalant group ( 69 vs. 43 % , log‐rank P = 0.002 ) . No serious adverse events occurred . Conclusion Vernakalant was superior to ibutilide in converting recent‐onset atrial fibrillation to sinus rhythm in the emergency department setting
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 ) .