Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: a systematic review and meta-analysis – Kevin J Um, William F McIntyre, Jeff S Healey, Pablo A Mendoza, Alex Koziarz, Guy Amit, Victor A Chu, Richard P Whitlock, Emilie P Belley-Côté – EP Europace, euy310, Published: 15 March 2019 Article history -> Received: 24 October 2018 Accepted: 03 December 2018


Clinicians pre-treat patients with amiodarone to increase the efficacy of electrical cardioversion for atrial fibrillation (AF). We conducted a systematic review and meta-analysis of randomized controlled trials comparing pre- and post-treatment for electrical cardioversion with amiodarone versus no therapy on (i) acute restoration and (ii) maintenance of sinus rhythm after 1 year. We searched MEDLINE and EMBASE from inception to July 2018. We evaluated the risk of bias with the Cochrane tool and overall quality of evidence with the GRADE framework. We identified 8 eligible studies (n = 1012). Treatment with amiodarone (200–800 mg daily for 1–6 weeks pre-cardioversion; 0–200 mg daily post-cardioversion) was associated with higher rates of acute restoration [relative risk (RR) 1.22, 95% confidence interval (CI) 1.07–1.39, P = 0.004, n = 1012, I2 = 65%] and maintenance of sinus rhythm over 13 months (RR 4.39, 95% CI 2.99–6.45, P < 0.001, n = 695, I2 = 0%). The effects for acute restoration were maintained when considering only studies at low risk of bias (RR 1.22, 95% CI 1.10–1.36, P < 0.001, n = 572, I2 = 0%). Adverse effects were typically non-serious, occurring in 3.4% (6/174) of amiodarone-treated subjects. High-quality evidence demonstrated that treatment with amiodarone improved the acute restoration and maintenance of sinus rhythm for electrical cardioversion of AF. Short-term amiodarone was well-tolerated.Atrial fibrillation, Antiarrhythmic drugs, Amiodarone, Electrical cardioversion, Meta-analysis Topic:

Issue Section: Review


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