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Cited by 245Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmias

Mixed treatment comparison of dronedarone, amiodarone, sotalol, flecainide, and propafenone, for the management of atrial fibrillation

Freemantle, N., Lafuente-Lafuente, C., Mitchell, S., Eckert, L., Reynolds, M.·2011·Europace
DOI 10.1093/europace/euq450
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Abstract

AIMS: Mixed treatment comparisons (MTC) were performed to assess the relative efficacy and tolerability of the main anti-arrhythmic drugs used for the treatment of atrial fibrillation (AF)/flutter. METHODS AND RESULTS: Electronic databases were systematically searched to identify randomized controlled trials (RCTs) examining amiodarone, dronedarone, flecainide, propafenone, sotalol, or placebo for the treatment of AF. Thirty-nine RCTs met inclusion criteria and were combined using MTC models to provide direct and indirect comparisons in a single analysis. Results are presented vs. placebo. Amiodarone had the largest effect in reducing AF recurrence (OR 0.22, 95% CI 0.16-0.29). Amiodarone was associated with the highest rate of patients experiencing at least one serious adverse event (OR 2.41, 95% CI 0.96-6.06) and treatment withdrawals due to adverse events (OR 2.91, 95% CI 1.66-5.11). Dronedarone was associated with the lowest rate of proarrhythmic events including bradycardia (OR 1.45, 95% CI 1.02-2.08). Dronedarone significantly reduced the risk of stroke (OR 0.69, 95% CI 0.57-0.84). Trends towards increased mortality for sotalol (OR 3.44, 95% CI 1.02-11.59) and amiodarone (OR 2.17, 95% CI 0.63-7.51) were found, which were stronger when small studies randomizing <100 subjects per group were excluded. CONCLUSIONS: Amiodarone has been demonstrated to be the most effective drug in maintaining sinus rhythm. Differences in outcomes between the anti-antiarrhythmic drugs were reported, with sotalol and possibly amiodarone increasing mortality and dronedarone possibly decreasing the incidence of serious adverse events and proarrhythmia.

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  • Quinidine and disopyramide are associated with increased all-cause mortality at 1-year follow-up (OR 2.39; 95% CI 1.03-5.59; number needed to harm 109; 95% CI 34-4985), likely due to ventricular arrhythmias (torsades de pointes).

    “Quinidine and disopyramide have been associated with an increase in all-cause mortality (OR 2.39; 95% CI 1.03-5.59;number needed to harm 109; 95% CI 34-4985) at 1-year follow-up, 580, 661 likely due to ventricular arrhythmias (torsades de pointes).580,661”

    From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [661]

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Authors
Freemantle, N., Lafuente-Lafuente, C., Mitchell, S., Eckert, L., & Reynolds, M.
Affiliations
  • University of Birmingham (GB)
  • Sanofi (France) (FR)
  • Beth Israel Deaconess Medical Center (US)
Corresponding author
Eckert, L.
ORCID
Venue
Europace
Publisher
Oxford University Press (OUP)
Published
2011-01-11
Volume
13
Issue
3
Pages
329-345
ISSN
  • 1099-5129 (ISSN-L)
  • 1532-2092
DOI
10.1093/europace/euq450
OpenAlex
W2010627883
Cited by
245
References
65
Citations by year
2026: 5 · 2025: 14 · 2024: 18 · 2023: 14 · 2022: 20 · 2021: 14 · 2020: 12 · 2019: 12 · 2018: 15 · 2017: 12 · 2016: 24 · 2015: 19 · 2014: 22 · 2013: 7 · 2012: 25
FWCI
14.47
Type
journal article
Language
en
Open access
closed
Locations
  • EP Europace (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
atrial fibrillation, antiarrhythmic drugs, dronedarone, amiodarone, sotalol, flecainide, propafenone, atrial flutter, atrial fibrillation recurrence, drug-induced arrhythmia, stroke prevention, mortality, drug tolerability, sinus rhythm maintenance
MeSH terms
Dronedarone, Aged, Amiodarone, Anti-Arrhythmia Agents, Atrial Fibrillation, Female, Flecainide, Humans, Male, Middle Aged, Propafenone, Sotalol, Randomized Controlled Trials as Topic, Treatment Outcome

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