 |
|
Effectiveness of Amiodarone for Conversion of Atrial Fibrillation to Sinus Rhythm
A Meta-analysis
Luz M. Letelier, MD;
Kamol Udol, MD, MSc;
Javier Ena, MD;
Bruce Weaver, MSc;
Gordon H. Guyatt, MD, MSc, FRCPC
Arch Intern Med. 2003;163:777-785.
Background Although clinicians sometimes choose amiodarone to convert atrial fibrillation (AF) to sinus rhythm, no current and comprehensive systematic review has summarized its effectiveness.
Objective To review the effectiveness of amiodarone in converting AF to sinus rhythm over a 4-week period.
Methods Two reviewers conducted a systematic search for randomized trials in databases, complemented by hand searches and contact with experts. Selected trials compared amiodarone with placebo, digoxin, or calcium channel blockers for conversion of AF to sinus rhythm. Reviewers evaluated the methodology and extracted data from each primary study.
Results Twenty-one studies met eligibility criteria. Duration of AF proved to be a source of heterogeneity, leading to 2 analyses. The relative risk (RR) for achieving sinus rhythm was 4.33 (95% confidence interval [CI], 2.76-6.77) for trials with mean AF duration of greater than 48 hours and 1.40 (95% CI, 1.25-1.57) for those with AF of 48 hours or less. The risk differences for these 2 groups were 27% and 26%, respectively, yielding a number needed to treat of 4 for both groups. The low control event rate among trials with long duration of AF, compared with that of trials with a duration of 48 hours or less, explained the difference in the RR for conversion. We found that the size of the left atrium, presence of cardiovascular disease, and protocols of amiodarone administration did not influence the magnitude of effect. Serious adverse events were infrequent.
Conclusions Amiodarone is effective for converting AF to sinus rhythm in a wide range of patients. Although use of amiodarone is apparently safe, safety data are too scarce for definitive conclusions.
From the Departments of Internal Medicine, Sotero del Rio Hospital, Universidad Catolica, Santiago, Chile (Dr Letelier), and Marina Baixa Hospital, Villajoyosa, Alicante, Spain (Dr Ena); the Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (Dr Udol); and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario (Mr Weaver and Dr Guyatt). The authors have no relevant financial interest in this article.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Prescribing Amiodarone: An Evidence-Based Review of Clinical Indications
Vassallo and Trohman
JAMA 2007;298:1312-1322.
ABSTRACT
| FULL TEXT
Sex Differences in the Relationship Between Amiodarone Use and the Need for Permanent Pacing in Patients With Atrial Fibrillation
Essebag et al.
Arch Intern Med 2007;167:1648-1653.
ABSTRACT
| FULL TEXT
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Writing Committee Members et al.
Europace 2006;8:651-745.
FULL TEXT
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Fuster et al.
J Am Coll Cardiol 2006;48:e149-e246.
FULL TEXT
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Fuster et al.
Circulation 2006;114:e257-e354.
FULL TEXT
ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB
Evid. Based Med. 2004;9:3-3.
FULL TEXT
Rate or rhythm control in persistent atrial fibrillation?
Boos et al.
QJM 2003;96:881-892.
ABSTRACT
| FULL TEXT
|
