Key result
Antazoline increases AF conversion to sinus rhythm ~13% versus propafenone without raising adverse events.
Why the study?
Direct comparative evidence evaluating antazoline against standard antiarrhythmic agents for the pharmacological cardioversion of recent-onset AF remains limited.
Does intravenous antazoline improve conversion to sinus rhythm in adult patients with atrial fibrillation compared to propafenone or amiodarone?
Meta-Analysis (n=3,221)
Does intravenous antazoline improve conversion to sinus rhythm in adult patients with atrial fibrillation compared to propafenone or amiodarone?
Relative Risk: 1.13 (95% CI 1.04–1.23)
p-value: p=.017
Intravenous antazoline is more effective than propafenone and amiodarone for the rapid pharmacological cardioversion of atrial fibrillation, without an increased risk of adverse events.
Antazoline may support pharmacological AF cardioversion; leaves open need for larger trials to guide adoption.
Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Antazoline, a first-generation antihistamine with antiarrhythmic properties, has shown efficacy in the rapid conversion of recent-onset AF to sinus rhythm; however, direct comparative evidence against standard antiarrhythmic agents remains limited. This study aims to systematically evaluate the efficacy and safety of antazoline for pharmacological cardioversion of AF, in comparison with standard antiarrhythmic agents such as amiodarone and propafenone. Methods: The methodology of this systematic review and meta-analysis adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search was conducted in ScienceDirect, Embase, PubMed, and Cochrane Library from inception to April 2025, including citation and reference screening. Statistical analyses were performed using R version 2025.05.0 + 496. Results: From 172 records, 5 studies comparing antazoline with propafenone (n = 5) or amiodarone (n = 3) for AF were included. For antazoline vs propafenone, conversion to sinus rhythm favored antazoline (risk ratio [RR] 1.13 [95% confidence interval (CI): 1.04–1.23], P = .017). No significant difference was observed in time to conversion (mean difference −10.98 [95% CI: −124.93–102.98], P = .436), bradycardia (RR 0.84 [95% CI: 0.35–2.03], P = .478), hypotension (RR 0.40 [95% CI: 0.14–1.12], P = .056), or other adverse events (RR 1.24 [95% CI: 0.01–247.13], P = .694). For antazoline vs amiodarone, conversion to sinus rhythm favored antazoline (RR 1.22 [95% CI: 1.08–1.36], P = .018, I 2 = 0%), with no significant differences in bradycardia (RR 1.36 [95% CI: 0–1072357.09], P = .823) or hypotension (RR 1.05 [95% CI: 0.04–26.16], P = .877). Conclusion: Antazoline might be more effective than propafenone and amiodarone in achieving sinus rhythm in AF, with no significant differences in safety outcomes.
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Bakht et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=3,221). Antazoline vs. Propafenone was evaluated on Conversion of AF to sinus rhythm (RR 1.13, 95% CI 1.04-1.23, p=.017). Antazoline significantly increased the successful conversion of atrial fibrillation to sinus rhythm compared to propafenone (RR 1.13) and amiodarone (RR 1.22), without increasing the risk of adverse events.
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