Efficacy and Safety of Ibutilide for the Cardioversion of Atrial Fibrillation: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Gong CC ◽  
◽  
Tang Y ◽  
Huang Y ◽  
Liu X ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Torsade De Pointes ◽  
Polymorphic Ventricular Tachycardia ◽  
Efficacy And Safety ◽  
Eligibility Criteria ◽  
Recent Onset ◽  
Successful Termination ◽  
Onset Atrial Fibrillation

Background: Ibutilide has been approved for cardioversion of Atrial Fibrillation (AF), but its side-effects include a high risk of torsade de pointes, besides, one recent meta-analysis showed ibutilide was inferior to vernakalant for conversion (AF<7 days). Hence, the aim of this study is to evaluate the efficacy and safety of ibutilide for the cardioversion of AF within 90 days. Methods: The Embase, PubMed, Web of Science, Cochrane Central databases and clinical trials.gov were comprehensively searched for relevant studies from January 1991 to May 2020 using the keywords “ibutilide” and “atrial fibrillation”. Only Randomized Controlled Trials (RCTs) comparing ibutilide with placebo or other Anti-Arrhythmic Drugs (AADs) for the termination of AF (duration of AF ≤90 days) were included. The primary outcome was successful cardioversion in response to ibutilide versus placebo or other AADs within 4h. Related adverse events were defined as secondary outcomes. Results: A total of 1712 patients in 13 RCTs met the eligibility criteria. Four trials compared ibutilide to placebo; nine trials compared ibutilide to other active drugs. The results revealed that ibutilide had a higher success rate for the termination of recent-onset atrial fibrillation compared to placebo within 4h [Risk Ratio (RR), 4.64; 95% Confidence Interval (CI), 1.30-16.56, P=0.006]; and ibutilide also showed superiority to DL-sotalol, Propafenone, Procainamide for successful termination of recent-onset AF within 4h. As compared to other active drugs, Ibutilide was associated with a lower risk of hypotension (RR 0.23, 95% CI 0.09-0.57, P=0.002); but significantly increased the incidence of Polymorphic ventricular tachycardia (RR 3.78, 95% CI 1.08-13.23, P=0.04). Conclusion: Intravenous ibutilide could be an accessible choice for the cardioversion of recent-onset AF patients without contraindications, but under strict monitored condition is needed for at least 6 hours.

Efficacy and Safety of Vernakalant in Recent-Onset Atrial Fibrillation After the European Medicines Agency Approval: Systematic Review and Meta-Analysis

2012 ◽  
Vol 52 (12) ◽  
pp. 1872-1878 ◽  
Author(s):  
Francesco Buccelletti ◽  
Paolo Iacomini ◽  
Gianfranco Botta ◽  
Davide Marsiliani ◽  
Annarita Carroccia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Meta Analysis ◽  
European Medicines Agency ◽  
Efficacy And Safety ◽  
Recent Onset ◽  
Onset Atrial Fibrillation

Pharmacologic cardioversion of recent-onset atrial fibrillation: a systematic review and network meta-analysis

EP Europace ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 854-869 ◽  
Author(s):  
Ian S deSouza ◽  
Mina Tadrous ◽  
Theresa Sexton ◽  
Roshanak Benabbas ◽  
Guy Carmelli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Sinus Rhythm ◽  
English Language ◽  
Human Subjects ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Placebo Control ◽  
Recent Onset ◽  
Onset Atrial Fibrillation

Abstract Aims We sought to identify the most effective antidysrhythmic drug for pharmacologic cardioversion of recent-onset atrial fibrillation (AF). Methods and results We searched MEDLINE, Embase, and Web of Science from inception to March 2019, limited to human subjects and English language. We also searched for unpublished data. We limited studies to randomized controlled trials that enrolled adult patients with AF ≤ 48 h and compared antidysrhythmic agents, placebo, or control. We determined these outcomes prior to data extraction: (i) rate of conversion to sinus rhythm within 24 h, (ii) time to cardioversion to sinus rhythm, (iii) rate of significant adverse events, and (iv) rate of thromboembolism within 30 days. We extracted data according to PRISMA-NMA and appraised selected trials using the Cochrane review handbook. The systematic review initially identified 640 studies; 30 met inclusion criteria. Twenty-one trials that randomized 2785 patients provided efficacy data for the conversion rate outcome. Bayesian network meta-analysis using a random-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. Overall quality was low, and the network exhibited inconsistency. Probabilistic analysis ranked vernakalant and flecainide high and propafenone and amiodarone IV low. Conclusion 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. Further high-quality study is necessary.

scholarly journals Intravenous vernakalant in comparison with intravenous flecainide in the cardioversion of recent-onset atrial fibrillation

2017 ◽  
Vol 8 (2) ◽  
pp. 114-120 ◽  
Author(s):  
Hanna Pohjantähti-Maaroos ◽  
Harri Hyppölä ◽  
Maria Lekkala ◽  
Emma Sinisalo ◽  
Antti Heikkola ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Female Gender ◽  
Efficacy And Safety ◽  
Single Centre ◽  
Recent Onset ◽  
The Difference ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation

Background: Pharmacological cardioversion of atrial fibrillation is a reasonable alternative for electrical cardioversion in acute atrial fibrillation. We compared the efficacy and safety of intravenous vernakalant and intravenous flecainide in patients with recent-onset (< 48 h) atrial fibrillation. Methods: A total of 200 consecutive patients, 100 patients undergoing cardioversion with intravenous vernakalant and 100 patients undergoing cardioversion with intravenous flecainide, were included in this single centre non-randomized retrospective study. The primary endpoint was conversion to sinus rhythm within 120 minutes from the drug administration. Results: Cardioversion was successful in 67% of patients treated with vernakalant and in 46% of patients treated with flecainide ( p=0.003). Vernakalant (odds ratio 1.99, 95% confidence interval 1.08–3.69, p=0.029) and female gender (odds ratio 2.48, 95% confidence interval 1.22–15.05, p=0.012) were significant predictors of successful cardioversion. The success rate of cardioversion was lowest among men treated with flecainide (36.9%). Patients treated with vernakalant were discharged earlier from the emergency department compared with those treated with flecainide (8.2 ± 4.7 h vs. 12.0 ± 6.0 h, p < 0.001). There was no difference in the complication rate between the groups. Vernakalant treated patients were older (59.3 ± 12.5 vs. 55.4 ± 13.0 years, p=0.03), had higher CHA2DS2-VASc score (1.4 ± 1.3 vs. 0.9 ± 1.2, p = 0.002) and were more often on beta-blocker medication (59% vs. 42%, p= 0.016) than flecainide treated patients. Conclusion: Vernakalant was safe, more effective and faster than flecainide in the cardioversion of recent-onset atrial fibrillation. The difference in efficacy was especially apparent among men.

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