CLINICAL STUDY: CARDIAC ELECTROPHYSIOLOGY
Amiodarone versus placebo and class ic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis
Philippe Chevalier, MD, PhD*,*,
Alexis Durand-Dubief, MD*,
Haran Burri, MD*,
Michel Cucherat, MD ,
Gilbert Kirkorian, MD* and
Paul Touboul, MD*
* Département de cardiologie et de soins intensifs, Hôpital Louis Pradel, Lyon, France
Service de pharmacologie clinique–EA 643 et Service de Biostatistique, Hôpitaux de Lyon, Lyon, France
Manuscript received May 13, 2002;
revised manuscript received August 9, 2002,
accepted August 29, 2002.
* Reprint requests and correspondence: Prof. Philippe Chevalier, Hôpital Louis Pradel, 28, Avenue Doyen Lépine, 69 394 Lyon Cedex 03, France.
philippe.chevalier{at}chu-lyon.fr
OBJECTIVES: This meta-analysis compared amiodarone with placebo and class Ic drugs for the cardioversion of recent-onset atrial fibrillation (AF), defined as lasting less than seven days.
BACKGROUND: Despite the lack of trials that support its efficacy convincingly, amiodarone is widely used for conversion of recent-onset AF.
METHODS: We searched Medline and EMBASE databases, as well as the Cochrane Controlled Trials Register for randomized trials on recent-onset AF comparing amiodarone to placebo or class Ic drugs. Data were combined according to a fixed effect model. The primary end point was the rate of conversion at 24 h. To study time-dependency of the drugs, efficacy at 1 to 2 h, 3 to 5 h, 6 to 8 h, and at 24 h was analyzed.
RESULTS: We found six studies randomizing amiodarone versus placebo (595 patients) and seven studies versus class Ic drugs (579 patients). There was no significant difference between amiodarone and placebo at 1 to 2 h, but significant efficacy was found after 6 to 8 h (relative risk [RR] 1.23, p = 0.022) and at 24 h (RR 1.44, p < 0.001). Efficacy with amiodarone was inferior to class Ic drugs for up to 8 h (RR 0.67, p < 0.001) but no difference was seen at 24 h (RR 0.95, p = 0.50). There were no major adverse effects.
CONCLUSIONS: Amiodarone is superior to placebo for cardioversion of AF, and even though the onset of conversion is delayed, its efficacy is similar at 24 h compared with class Ic drugs. These results favor amiodarone as a reasonable alternative for patients with recent AF in whom class Ic and other, more rapidly acting antiarrhythmic drugs cannot be used.
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Abbreviations and Acronyms
| | AF | | atrial fibrillation | | CI | | confidence intervals | | RR | | relative risk |
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