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 ) .
Efficacy and tolerability of oral propafenone versus quinidine in the treatment of recent onset atrial fibrillation: A randomized, prospective study.
BACKGROUND A prospect i ve , r and omized study was conducted to evaluate the efficacy and tolerability of oral propafenone and quinidine for the conversion of paroxysmal atrial fibrillation ( AF ) . METHODS Eighty one consecutive patients ( female/male 46/35 ; mean age 64.0 + /- 11.6 ) , admitted to hospital with AF lasting no longer than 48 hours , were r and omized in terms of their pharmacological therapy . Forty three patients ( 55 % ) were r and omly assigned to Group I and received propafenone 600 mg orally as the initial therapy , with an additional dose of 300 mg after eight hours , if the sinus rhythm had not been restored by then . Thirty eight patients ( 45 % ) ( Group II ) received 1 mg digoxin IV followed by an oral loading of quinidine ( 400 mg followed by 200 mg every two hours ) . RESULTS The conversion rate assessed after 24 hours was the same in both groups ( Gr . I vs. Gr . II : 90.7 vs. 91.4 % ) , with the same number of mild side effects ( Gr . I vs. Gr . II : 37.2 % vs. 45.7 % ) . No life-threatening adverse events were reported . Propafenone achieved a higher efficacy rate during the first eight hours ( 83.3 vs. 54.3 % ; p = 0.01 ) , with a significantly shorter time required to sinus rhythm recovery throughout the study period , with a median time of 165 min ( 95 % confidence interval 120 - 278 ) vs. 360 min ( 95 % confidence interval 298 - 650 ; p < 0.05 ) . There was some indication of greater effectiveness of propafenone than quinidine in early sinus rhythm restoration in patients with : no structural heart disease , in those with an AF duration shorter than 12 hours , and in patients with an ejection fraction > 55 % . CONCLUSIONS Although both drugs revealed the same effectiveness , the conversion to sinus rhythm in the group treated with propafenone was observed more quickly despite the longer paroxysmal AF episode duration
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 ) .