Conversion of atrial fibrillation to sinus rhythm and rate control by digoxin in comparison to placebo. Table 1 describes the characteristics of the 21 included studies.3,11,12,16-33 Of the 21 authors we contacted, 13 (62%) responded to our request for additional information on their trials.11,12,17,19,20,22-24,28,29,31-33. MRSegal RGuyatt To review the effectiveness of amiodarone in converting AF to sinus rhythm over a 4-week period. All Rights Reserved. Little data is available for use of lower doses. Methods et al. IHayes 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. NLManagement of new onset atrial fibrillation. MLilja Amiodarone is used to treat certain types of serious (possibly fatal) irregular heartbeat (such as persistent ventricular fibrillation / tachycardia ). However, we tried to minimize bias through the use of explicit inclusion criteria and 2 independent reviewers. Hohnloser GEIgoumenidis Care. We used both safeguards in our study. government site. MDavey Smith Table 3 shows the range of percentages, among studies, of patients with major AEs, as previously defined, for each treatment group. Our review has a number of strengths, including a comprehensive literature search, explicit eligibility criteria, independent adjudication of eligibility by 2 reviewers with high agreement, and systematic and independent assessment of methodological quality. By submitting a comment you agree to abide by our Terms and Community Guidelines. ChildrenUse and dose must be determined by your doctor. and transmitted securely. Unauthorized use of these marks is strictly prohibited. The drug prevents the recurrence of life-threatening ventricular arrhythmias. Amiodarone as compared to digitalis was associated with a clinically relevant faster time to heart rate control<110bpm (2h (IQR: 1h to 6h) versus 4h (2h to 12h); p=0.003) and longer durations of sinus rhythm during the first 24h of treatment (6h (IQR: 6h to 22h) versus 0h (IQR: 0h to 16h); p<0.001). Drikite et al. In the high dose group, electrocardioversions were performed before study end because of persistent tachycardia in two patients. 61, 1820. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Within this group, time to heart rate control<110bpm was reached earlier in patients receiving amiodarone as compared to digitalis (2h [IQR: 1h to 6h] versus 4h (2h to 12h); p=0.003). sharing sensitive information, make sure youre on a federal Google Scholar. Lenient versus strict rate control in patients with atrial fibrillation. Diagram of the selection process. et al. et al. We included studies that met the following criteria: (1) Patients had AF of any etiology and duration; (2) The intervention consisted of amiodarone compared with placebo, digoxin, CCB, or no treatment (control group); (3) The primary outcome consisted of conversion to sinus rhythm during a period of 4 weeks or less; and (4) The design consisted of randomized or quasi-randomized clinical trials. Describe interprofessional team strategies for improving care coordination and communication to advance the knowledge on amiodarone and improve outcomes. We used weighted statistics to measure chance-corrected agreement13 between independent reviewers in selection, inclusion, and quality assessment. Results for the primary end point significantly favoured the high dose group. Effectiveness of heart rate control in digitalis treated patients and digitalis dosing were comparable to study data by Herasevich et al., who reported a decrease in heart rate of 23bpm followed by a slight increase in systolic blood pressures12. 2023 American Medical Association. However, more bradycardic episodes occurred in association with amiodarone than with digitalis (7.7% versus 3.4%; p=0.019). Amiodarone may be more effective with regard to conversion into sinus rhythm and heart rate slowing. Reviewers classified concealment of treatment allocation as adequate if those enrolling patients called a central randomization facility or opened sealed opaque envelopes or if the central pharmacy prepared and distributed numbered drug kits. This product is available in the following dosage forms: Tablet https://doi.org/10.1097/eja.0000000000000627 (2017). independently extracted, in duplicate, data regarding patient characteristics, the amiodarone and comparison drug therapy regimens, rate of conversion to sinus rhythm, mortality, and AEs from each article. Effectiveness of amiodarone versus digitalis for heart rate control in critically ill patients with new-onset atrial fibrillation, https://doi.org/10.1038/s41598-022-06639-0. Selection bias was minimised as allocation was not known to the investigators before informed consent had been obtained. Approved as a pharmacy medicine, Sanofi will launch Cialis Together in the second half of the year. ATomassoni Ethical approval for this retrospective study (Ethical Committee N 9219_BO_K_2020) was provided by Hannover Medical School Ethics Committee, Hannover, Germany (Chairperson Prof. S. Engeli) on 21st of July 2020, the requirement for informed consent was waived. DMontori AGuyatt JCDeveloping optimal search strategies for detecting clinically sound studies in MEDLINE. For each study, the number after the parenthetical confidence interval (CI) is the number of included patients. Sixteen studies used intravenous infusion for 24 hours or less and then stopped therapy or continued administration of oral amiodarone. Acute treatment of recent-onset atrial fibrillation and flutter with a tailored dosing regimen of intravenous amiodarone. The presence of severe co-morbidity in the majority of patients is considered pro-arrhythmic and would be expected to reduce the rate of conversion, and also increase the probability of recurrence of arrhythmia, as compared to that in more selected populations. Boxplots (whiskers: 5th and 95th percentile) show representative heart rates for patients treated with amiodarone (red) or digitalis (blue) during the study interval. MJuvonen GJLee However, we found no evidence of increased occurrence of any of the AEs in the amiodarone group when compared with any of the control groups. Finally, when considering the advantages and disadvantages of including unpublished studies such as abstracts, most clinical trials and methodologists believe the advantages outweigh the disadvantages.44. CTAdverse effects of low dose amiodarone: a meta-analysis. R For a study that compared amiodarone with digoxin or diltiazem hydrochloride,11 our analysis pooled data from the 2 control arms; for a study that compared placebo with 2 different doses of amiodarone,12 we pooled data from the amiodarone arms. Baseline characteristics of the included patients are shown in Table 1. Patients treated with amiodarone had a significantly longer duration of hours in sinus rhythm than digitalis treated patients within 24h of treatment initiation (6h [IQR: 6h to 22h] versus 0h [IQR: 0h to 16h]; p<0.001). Amiodarone is widely prescribed, largely due to its efficacy in the management of both supraventricular and ventricular arrhythmias. 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. JP Hence, their quality would be similar to those of randomized trials in which concealment was inadequate. For clinicians who remain uncomfortable with pooling, given the variability in patients and ways of administering amiodarone, our results remain informative. Our review has some limitations. MRA prospective, randomized controlled trial comparing the efficacy and safety of sotalol, amiodarone, and digoxin for the reversion of new-onset atrial fibrillation. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in We sought to determine the lowest effective dose for rhythm control in a single physician practice. Introduction: Amiodarone is the most effective drug for the treatment of atrial fibrillation (AF), but long-term administration of standard doses can have prohibitive side effects. Patients in need of a cardioversion after medication were also excluded, because we intended to examine solely the effectiveness of amiodarone or digitalis medication for heart rate control. Heart rates both in patients treated with either amiodarone or digitalis decreased over time (Friedman test: p<0.001 for both groups). Wyse Kochiadakis The higher the control event rate (baseline risk) of the desirable outcome, conversion to sinus rhythm, the lower is the maximum possible RR. Sci Rep 12, 2712 (2022). Amiodarone is known as an anti-arrhythmic drug. ALenzi Furthermore, as shown in Table 2, the point estimates of the RR for conversion for abstracts and full articles (1.48 vs 1.35; P = .37) were similar, and differences are attributable to chance. Egger This raises the possibility of an apparently low RR in the group of studies with short AF duration, even if the drug is highly effective. Kaplan-Meier diagram showing the rate of conversion during the study period (n = 100; p < 0.05). Vardas MMinder Such patients constituted a significant part of our material. This might be explained by a difference in the included patient collectives between the two studies. The anaesthesia intensive care unit is one of six independent surgical intensive care units at Hannover Medical School, a tertiary referral hospital, and provides care for a mixed patient collective (approximately 80% post-surgery, 10% post-interventional and 10% medical cases). The https:// ensures that you are connecting to the DAnastasiou-Nana Citations that 1 reviewer considered relevant were further assessed independently by 2 of us (L.M.L. 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