Why the study?
Do anti-arrhythmic drugs improve conversion to sinus rhythm within 24 hours in patients with recent-onset atrial fibrillation?
Do anti-arrhythmic drugs improve conversion to sinus rhythm within 24 hours in patients with recent-onset atrial fibrillation?
Answers are grounded in this paper and cite their sources.
Vernakalant provides rapid conversion of recent-onset AF, while flecainide and propafenone are effective options for patients without structural heart disease.
OBJECTIVES: Recent-onset (duration ≤ 1 week) atrial fibrillation (AF) has a high rate of spontaneous conversion to sinus rhythm (SR); still anti-arrhythmic drugs (AAD) are given for conversion purposes. We assessed the effect of AADs by reviewing the literature regarding conversion rates of available drugs in a systematic manner. DESIGN: PubMed searches were performed using the terms "drug name", "atrial fibrillation", and "clinical study/RCT", and a list of 1302 titles was generated. These titles, including abstracts or complete papers when needed, were reviewed for recent-onset of AF, the use of a control group, and the endpoint of SR within 24 hours. Postoperative and intensive care settings were excluded. RESULTS: Five AADs were demonstrated to have an effect, and these were Amiodarone, Ibutilide (only one study and risk of torsade de pointes), Flecainide and Propafenone (only to be used in patients without structural heart disease) and Vernakalant. The time taken for conversion differed markedly; Vernakalant converted after 10 minutes, while Amiodarone converted only after 24 hours; Propafenone and Flecainide had conversion times in-between. CONCLUSIONS: For a rapid response in a broad group of patients, Vernakalant appears to be a reasonable first choice, while Flecainide and Propafenone can be used in patients without structural heart disease.
No takes yet. Share an insight, caveat, or question.
Heldal et al. (2012) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: