Effect of Early Pharmacologic Cardioversion vs. Non-early Cardioversion in the Patients With Recent-Onset Atrial Fibrillation Within 4-Week Follow-Up Period: A Systematic Review and Network Meta-Analysis

Figure 1. Flowchart showing the procedure for identifying the relevant publications. The antiarrhythmic drugs as early pharmacologic cardioversion in the study included amiodarone, propafenone, flecainide, tedisamil, vernakalant, vanoxerine, and sotalol.

Figure 2. Network meta-analysis of available comparisons. Circular nodes show different antiarrhythmic drugs as early pharmacologic cardioversion and non-early cardioversion. The antiarrhythmic drugs in the study included amiodarone, propafenone, flecainide, tedisamil, vernakalant, vanoxerine, and sotalol. Line width is proportional to the number of trials including each pair of treatments (direct comparisons). TIA, Transient Ischemic Attack.

Figure 3. Network meta-analysis results for all endpoints between early pharmacologic cardioversion and non-early cardioversion. The forest plot was based on the Bayesian framework. The antiarrhythmic drugs as early pharmacologic cardioversion in the study included amiodarone, propafenone, flecainide, tedisamil, vernakalant, vanoxerine, and sotalol. All endpoints are efficacy endpoints including cardioversion to sinus rhythm within 24 h, maintenance in sinus rhythm within 1-week and maintenance in sinus rhythm within 1–4-weeks, safety endpoints including bradycardia, tachyarrhythmia, hypotension, gastrointestinal disorders, and nervous system disorders, and prognostic endpoints including all-cause mortality, stroke or TIA and heart failure. CrI, Credible Interval; TIA, Transient Ischemic Attack.

Figure 4. Rankograms demonstrate the probability of each therapy ranked across all endpoints. *The antiarrhythmic drugs as early pharmacologic cardioversion in the study included amiodarone, propafenone, flecainide, vernakalant, vanoxerine, and sotalol.†All endpoints are efficacy endpoints including cardioversion to sinus rhythm within 24 h, maintenance in sinus rhythm within 1-week and maintenance in sinus rhythm within 1–4-weeks, safety endpoints including bradycardia, tachyarrhythmia, hypotension, gastrointestinal disorders, and nervous system disorders, and prognostic endpoints including stroke or TIA and heart failure. TIA, Transient Ischemic Attack.

Figure 5. Subgroup analyses in recent-onset atrial fibrillation patients with or without mild/moderate structural heart disease or hypertension. CrI, Credible Interval.