• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (100)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in this journal  Topic Collections  • Cardiovascular System  • Review  • Arrhythmias  • Alert me on articles by topic  Social Bookmarking   What's this?

A Systematic Review of Randomized Controlled Trials

Carmelo Lafuente-Lafuente, MD; Stéphane Mouly, MD, PhD; Miguel Angel Longás-Tejero, MD, PhD; Isabelle Mahé, MD, PhD; Jean-François Bergmann, MD

Arch Intern Med. 2006;166:719-728.

Background  A variety of antiarrhythmic drugs have been used to prevent recurrence of atrial fibrillation after conversion to sinus rhythm. We performed a systematic review to determine the effect of long-term treatment with those drugs on death, embolisms, adverse effects, and atrial fibrillation recurrence.

Methods  We searched MEDLINE, EMBASE, the Cochrane Library (all up to May 2005), and the reference lists of retrieved articles. We included randomized controlled trials that compared any antiarrhythmic against control (placebo or no treatment) or another antiarrhythmic, for more than 6 months. Postoperative atrial fibrillation was excluded. Two evaluators independently reviewed the retrieved studies and extracted all data. Disagreements were resolved by discussion. All results were calculated at 1 year of follow-up.

Results  Forty-four trials were included, with a total of 11 322 patients. Several class IA (disopyramide phosphate, quinidine sulfate), class IC (flecainide acetate, propafenone hydrochloride), and class III (amiodarone, dofetilide, sotalol hydrochloride) drugs significantly reduced recurrence of atrial fibrillation (number needed to treat, 2-9), but all increased withdrawals due to adverse effects (number needed to harm [NNH], 9-27) and all but amiodarone and propafenone increased proarrhythmia (NNH, 17-119). Class IA drugs, pooled, were associated with increased mortality compared with controls (Peto odds ratio, 2.39; 95% confidence interval, 1.03-5.59; P = .04; NNH, 109). No other antiarrhythmic showed a significant effect on mortality compared with controls. We could not analyze other outcomes because data were lacking.

Conclusion  Class IA, IC, and III drugs are effective in maintaining sinus rhythm but increase adverse effects, and class IA drugs may increase mortality.

Author Affiliations: Service de Médecine Interne A, Hôpital Lariboisière, Paris, France (Drs Lafuente-Lafuente, Mouly, Mahé, and Bergmann); and Servicio de Cardiología, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain (Dr Longás-Tejero).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Ignoring Study Design Heterogeneity in Meta-analyses
J. Jaime Caro, James G. Xenakis, and Krista F. Huybrechts
Arch Intern Med. 2006;166(18):2046.
EXTRACT | FULL TEXT  

Ignoring Study Design Heterogeneity in Meta-analyses—Reply
Carmelo Lafuente-Lafuente, Stephane Mouly, Isabelle Mahe, and Jean-François Bergmann
Arch Intern Med. 2006;166(18):2046-2047.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Rationale and current perspective for early rhythm control therapy in atrial fibrillation
Van Gelder et al.
Europace 2011;13:1517-1525.
ABSTRACT | FULL TEXT  

A Randomized, Placebo-Controlled Study of Vernakalant (Oral) for the Prevention of Atrial Fibrillation Recurrence After Cardioversion
Torp-Pedersen et al.
Circ Arrhythm Electrophysiol 2011;4:637-643.
ABSTRACT | FULL TEXT  

Impact of dronedarone on hospitalization burden in patients with atrial fibrillation: results from the ATHENA study
Torp-Pedersen et al.
Europace 2011;13:1118-1126.
ABSTRACT | FULL TEXT  

Prevention of Recurrent Atrial Fibrillation With Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers: A Systematic Review and Meta-Analysis of Randomized Trials
Bhuriya et al.
J CARDIOVASC PHARMACOL THER 2011;16:178-184.
ABSTRACT  

Mixed treatment comparisons for atrial fibrillation: evidence network or bewildering entanglement?
Piccini and Kong
Europace 2011;13:295-296.
FULL TEXT  

Deja vu in the theories of atrial fibrillation dynamics
Jalife
Cardiovasc Res 2011;89:766-775.
ABSTRACT | FULL TEXT  

Review: Optimizing the Management of Atrial Fibrillation: Focus on Current Guidelines and the Impact of New Agents on Future Recommendations
Naccarelli and Curtis
J CARDIOVASC PHARMACOL THER 2010;15:244-256.
ABSTRACT  

Vernakalant: A novel agent for the termination of atrial fibrillation
Finnin
Am J Health Syst Pharm 2010;67:1157-1164.
ABSTRACT | FULL TEXT  

Antiarrhythmic Drugs: Safety First
Torp-Pedersen et al.
J Am Coll Cardiol 2010;55:1577-1579.
FULL TEXT  

Atrial fibrillation ablation in systolic heart failure patients: a promising tool?
Schmidt et al.
Europace 2010;12:1-2.
FULL TEXT  

Early and comprehensive management of atrial fibrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference 'research perspectives in AF'
Kirchhof et al.
Eur Heart J 2009;30:2969-2980.
ABSTRACT | FULL TEXT  

Pulmonary Vein Isolation for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation: A Meta-Analysis of Randomized, Controlled Trials
Piccini et al.
Circ Arrhythm Electrophysiol 2009;2:626-633.
ABSTRACT | FULL TEXT  

Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study)
Roux et al.
Circulation 2009;120:1036-1040.
ABSTRACT | FULL TEXT  

Comparative Efficacy of Dronedarone and Amiodarone for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation
Piccini et al.
J Am Coll Cardiol 2009;54:1089-1095.
ABSTRACT | FULL TEXT  

Amiodarone or Dronedarone for Atrial Fibrillation: Too Early to Know the Winner?
Chan et al.
J Am Coll Cardiol 2009;54:1096-1098.
FULL TEXT  

Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation'
Kirchhof et al.
Europace 2009;11:860-885.
FULL TEXT  

How safe is the antiarrhythmic drug therapy in atrial fibrillation?
Krishnamoorthy and Lip
Europace 2009;11:837-839.
FULL TEXT  

Antiarrhythmic Drug-Induced Internalization of the Atrial-Specific K+ Channel Kv1.5
Schumacher et al.
Circ. Res. 2009;104:1390-1398.
ABSTRACT | FULL TEXT  

CHAPTER 29 Atrial Fibrillation
Camm et al.
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT | FULL TEXT  

Atrial fibrillation ablation: beyond electro-mechanical matters
Martignani et al.
Eur Heart J 2008;29:2818-2819.
FULL TEXT  

Anti-arrhythmic drug therapy for atrial fibrillation: current anti-arrhythmic drugs, investigational agents, and innovative approaches
Savelieva and Camm
Europace 2008;10:647-665.
ABSTRACT | FULL TEXT  

An Irregularly Irregular Inheritance
London
J Am Coll Cardiol 2008;51:1090-1091.
FULL TEXT  

Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode
Cosio et al.
Europace 2008;10:21-27.
ABSTRACT | FULL TEXT  

Prescribing Amiodarone: An Evidence-Based Review of Clinical Indications
Vassallo and Trohman
JAMA 2007;298:1312-1322.
ABSTRACT | FULL TEXT  

Amiodarone-Induced Thyrotoxicosis: Clinical Course and Predictors of Outcome
Conen et al.
J Am Coll Cardiol 2007;49:2350-2355.
ABSTRACT | FULL TEXT  

A clinical and health-economic evaluation of pulmonary vein encircling ablation compared with antiarrhythmic drug treatment in patients with persistent atrial fibrillation (Catheter Ablation for the Cure of Atrial Fibrillation-2 study)
Bertaglia et al.
Europace 2007;9:182-185.
ABSTRACT | FULL TEXT  

Ignoring Study Design Heterogeneity in Meta-analyses.
Caro et al.
Arch Intern Med 2006;166:2046-2046.
FULL TEXT  

Ignoring Study Design Heterogeneity in Meta-analyses--Reply
Lafuente-Lafuente et al.
Arch Intern Med 2006;166:2046-2047.
FULL TEXT  

Antiarrhythmic Drugs for Managing AFib: A Meta-Analysis
Journal Watch Cardiology 2006;2006:2-2.
FULL TEXT