Evaluation of the efficacy and safety of different class III anti-arrhythmic drugs for treating patients with atrial fibrillation: a network meta-analysis
Abstract Background Class III anti-arrhythmic drugs (AADs) are used to control heart rhythm or rate in the management of atrial fibrillation (AF). In this study, we evaluated the most effective and safe class III AADs used to treat patients with AF. Methods We searched the PubMed, Cochrane Library, Web of Science, Embase, WanFang databases, as well as the China National Knowledge Infrastructure from 2014 to 2019 to identify studies that reported the use of class III ADDs to treat AF. Results We identified 31 articles (24 Chinese and 7 English), that included 2,894 AF patients (treatment group = 1,498, control group = 1,396) for our analysis. Several class III AADs showed significant treatment effects in AF patients compared to conventional treatment. The ADDs were ranked in terms of efficacy from good to bad as follows: vernakalant (relative risk (RR) =2.7, 95% confidence interval (CI):1.9-3.7), ibutilide (RR=2.0, 95% CI:1.7-2.4), nifekalant (RR=1.5, 95% CI:1.2-2.0), and amiodarone (RR=1.4,95% CI:1.3-1.5). There were no significant differences in the incidence of adverse reactions among the different class III AADs. These ADDs were ranked from least to most adverse reactions as follows: vernakalant(RR=0.46, 95% CI:0.20-1.0), sotalol (RR=0.52, 95% CI:0.25-1.0), ibutilide (RR=0.64, 95% CI:0.33-1.2), amiodarone (RR=0.79, 95% CI:0.58-1.1), and nifekalant (RR=1.0, 95% CI:0.44-2.5). Conclusion Our network meta-analysis shows that different class III AADs can be used to treat patients with AF both safely and effectively. Vernakalant appears to offer optimal therapeutic effect with minimal adverse reactions.