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 effectiveness of ranolazine plus amiodarone versus amiodarone alone for conversion of recent-onset atrial fibrillation.
Ranolazine , an antianginal agent with antiarrhythmic properties , prevents atrial fibrillation ( AF ) in patients with acute coronary syndrome . In experimental models , the combination of ranolazine and amiodarone has marked synergistic effects that potently suppress AF . Currently , the clinical effect of the ranolazine-amiodarone combination for the conversion of AF is unknown . This prospect i ve r and omized pilot study compared the safety and efficacy of ranolazine plus amiodarone versus amiodarone alone for the conversion of recent-onset AF . We enrolled 51 consecutive patients with AF ( < 48-hour duration ) eligible for pharmacologic cardioversion . Patients ( 33 men , 63 ± 8 years of age ) were r and omized to intravenous amiodarone for 24 hours ( group A , n = 26 ) or to intravenous amiodarone plus oral ranolazine 1,500 mg at time of r and omization ( group A + R , n = 25 ) . The 2 groups were well balanced with respect to clinical characteristics and left atrial diameter . Conversion within 24 hours ( primary end point ) was achieved in 22 patients ( 88 % ) in group A + R versus 17 patients ( 65 % ) in group A ( p = 0.056 ) . Time to conversion was shorter in group A + R than in group A ( 9.8 ± 4.1 vs 14.6 ± 5.3 hours , p = 0.002 ) . According to Cox regression analysis , left atrial diameter and A + R treatment were the only independent predictors of time to conversion ( hazard ratio 5.35 , 95 % confidence interval 2.37 to 12.11 , p < 0.001 ; hazard ratio 0.81 , 95 % confidence interval 0.74 to 0.88 , p < 0.001 , respectively ) . There were no proarrhythmic events in either group . In conclusion , addition of ranolazine to st and ard amiodarone therapy is equally safe and appears to be more effective compared to amiodarone alone for conversion of recent-onset AF
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 ) .