Intravenous amiodarone for conversion of atrial fibrillation: misled by meta-analysis?

Pharmacotherapy
R S Slavik, Peter J Zed

Abstract

Therapeutic goals for atrial fibrillation (AF) include ventricular rate control, stroke prevention, conversion to normal sinus rhythm, and maintenance of normal sinus rhythm. The optimal strategy of rate versus rhythm control for acute management of patients with AF is a continuing debate. However, selected patients may require acute treatment with antiarrhythmic agents for conversion of symptomatic AF episodes to normal sinus rhythm. Recently published randomized controlled trials, qualitative systematic reviews, meta-analyses, and evidence-based international consensus guidelines have addressed the controversy regarding acute conversion of AF using antiarrhythmic therapy. Although meta-analyses often provide the highest level of evidence, the validity and application of their results are based on the quality of their methodology and accuracy of reporting. Authors of the most recent meta-analysis of amiodarone for conversion of AF state that the drug is effective and relatively rapid acting in converting AF to normal sinus rhythm in a wide range of patients, and they recommend it as a first-line drug. We feel that these conclusions are overstated and potentially misleading due to methodologic limitations of the analysis. The r...Continue Reading

References

Jun 1, 1996·The Annals of Pharmacotherapy·M S Chow
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Sep 25, 2001·Progress in Cardiovascular Diseases·R S SlavikS Borzak
Dec 19, 2001·Annals of Internal Medicine·W H MaiselW G Stevenson
Dec 6, 2002·The New England Journal of Medicine·D G WyseUNKNOWN Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators
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Jul 17, 2003·Clinical Cardiology·Jacek CybulskiLeszek Ceremuzyński

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Citations

Nov 27, 2007·Critical Care : the Official Journal of the Critical Care Forum·Mengalvio E SleeswijkJan G Zijlstra
Jan 7, 2005·Regional Anesthesia and Pain Medicine·Peter H Pan, Robert D'Angelo

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