Cochrane · systematic review · CD005049
Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation
Valembois, L, Audureau, E, Takeda, A, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
HeartAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
45
current version
GRADE rated
40
No studies
5
Included studies
NR
No studies 5 · 11.1%Ungraded 0 · 0%Very low 4 · 8.9%Low 9 · 20%Moderate 17 · 37.8%High 10 · 22.2%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Quinidine compared to placebo or no treatment for maintaining sinus rhythm after cardioversion of atrial fibrillation
Population: adults in sinus rhythm after cardioversion of atrial fibrillation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Quinidine vs placebo or no treatment | RR 2.01 [0.84, 4.77] | 6 studies · 1646 participants | Low Downgraded: risk of bias, imprecision |
Withdrawals due to adverse effects Quinidine vs placebo or no treatment | RR 1.56 [0.87, 2.78] | 7 studies · 1669 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Proarrhythmia Quinidine vs placebo or no treatment | RR 2.05 [0.95, 4.41] | 7 studies · 1676 participants | High |
Stroke Quinidine vs placebo or no treatment | RR 0.97 [0.25, 3.83] | 4 studies · 1107 participants | Low Downgraded: risk of bias, imprecision |
Recurrence of atrial fibrillation Quinidine vs placebo or no treatment | RR 0.83 [0.78, 0.88] | 7 studies · 1624 participants | High |
Disopyramide compared to placebo or no treatment for maintaining sinus rhythm after cardioversion of atrial fibrillation
Population: adults in sinus rhythm after cardioversion of atrial fibrillation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Disopyramide vs placebo or no treatment | RR 5 [0.25, 101.37] | 1 study · 92 participants | Very low Downgraded: risk of bias, imprecision |
Withdrawals due to adverse effects Disopyramide vs placebo or no treatment | RR 3.68 [0.95, 14.24] | 2 studies · 146 participants | Low Downgraded: risk of bias, imprecision |
Proarrhythmia Disopyramide vs placebo or no treatment | no estimate extracted | NR | No studies |
Stroke Disopyramide vs placebo or no treatment | RR 0.31 [0.03, 2.91] | 2 studies · 146 participants | Very low Downgraded: risk of bias, imprecision |
Recurrence of atrial fibrillation Disopyramide vs placebo or no treatment | RR 0.77 [0.59, 1.01] | 2 studies · 146 participants | Low Downgraded: risk of bias, imprecision |
Propafenone compared to placebo or no treatment for maintaining sinus rhythm after cardioversion of atrial fibrillation
Population: adults in sinus rhythm after cardioversion of atrial fibrillation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Propafenone vs placebo or no treatment | RR 0.19 [0.02, 1.68] | 2 studies · 212 participants | Very low Downgraded: risk of bias, imprecision |
Withdrawals due to adverse effects Propafenone vs placebo or no treatment | RR 1.62 [1.07, 2.46] | 5 studies · 1098 participants | Moderate Downgraded: risk of bias |
Proarrhythmia Propafenone vs placebo or no treatment | RR 1.32 [0.39, 4.47] | 3 studies · 381 participants | Very low Downgraded: risk of bias, imprecision |
Stroke Propafenone vs placebo or no treatment | no estimate extracted | NR | No studies |
Recurrence of atrial fibrillation Propafenone vs placebo or no treatment | RR 0.67 [0.61, 0.74] | 5 studies · 1098 participants | Moderate Downgraded: risk of bias |
Flecainide compared to placebo or no treatment for maintaining sinus rhythm after cardioversion of atrial fibrillation
Population: adults in sinus rhythm after cardioversion of atrial fibrillation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Flecainide vs placebo or no treatment | no estimate extracted | NR | No studies |
Withdrawals due to adverse effects Flecainide vs placebo or no treatment | RR 15.41 [0.91, 260] | 1 study · 73 participants | Low Downgraded: risk of bias, imprecision |
Proarrhythmia Flecainide vs placebo or no treatment | RR 4.8 [1.3, 17.7] | 4 studies · 511 participants | Moderate Downgraded: risk of bias |
Stroke Flecainide vs placebo or no treatment | RR 2.04 [0.11, 39] | 1 study · 362 participants | Low Downgraded: risk of bias, imprecision |
Recurrence of atrial fibrillation Flecainide vs placebo or no treatment | RR 0.65 [0.55, 0.77] | 4 studies · 511 participants | High |
Metoprolol compared to placebo or no treatment for maintaining sinus rhythm after cardioversion of atrial fibrillation
Population: adults in sinus rhythm after cardioversion of atrial fibrillation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Metoprolol vs placebo or no treatment | RR 2.02 [0.37, 11.1] | 2 studies · 562 participants | Moderate Downgraded: imprecision |
Withdrawals due to adverse effects Metoprolol vs placebo or no treatment | RR 3.47 [1.48, 8.1] | 2 studies · 562 participants | High |
Proarrhythmia Metoprolol vs placebo or no treatment | RR 18.14 [2.42, 135.6] | 2 studies · 562 participants | High |
Stroke Metoprolol vs placebo or no treatment | no estimate extracted | NR | No studies |
Recurrence of atrial fibrillation Metoprolol vs placebo or no treatment | RR 0.83 [0.68, 1.02] | 2 studies · 562 participants | Moderate Downgraded: inconsistency |
Amiodarone compared to placebo or no treatment for maintaining sinus rhythm after cardioversion of atrial fibrillation
Population: adults in sinus rhythm after cardioversion of atrial fibrillation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Amiodarone vs placebo or no treatment | RR 1.66 [0.55, 4.99] | 2 studies · 444 participants | Moderate Downgraded: imprecision |
Withdrawals due to adverse effects Amiodarone vs placebo or no treatment | RR 6.7 [1.91, 23.45] | 4 studies · 319 participants | Low Downgraded: risk of bias, imprecision |
Proarrhythmia Amiodarone vs placebo or no treatment | RR 2.22 [0.71, 6.96] | 4 studies · 673 participants | Moderate Downgraded: risk of bias, imprecision |
Stroke Amiodarone vs placebo or no treatment | RR 1.15 [0.3, 4.39] | 1 study · 399 participants | Low Downgraded: imprecision |
Recurrence of atrial fibrillation Amiodarone vs placebo or no treatment | RR 0.52 [0.46, 0.58] | 6 studies · 812 participants | High |
Dofetilide compared to placebo or no treatment for maintaining sinus rhythm after cardioversion of atrial fibrillation
Population: adults in sinus rhythm after cardioversion of atrial fibrillation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Dofetilide vs placebo or no treatment | RR 0.98 [0.76, 1.27] | 3 studies · 1183 participants | Moderate Downgraded: risk of bias |
Withdrawals due to adverse effects Dofetilide vs placebo or no treatment | RR 1.77 [0.75, 4.2] | 2 studies · 677 participants | Low Downgraded: risk of bias, imprecision |
Proarrhythmia Dofetilide vs placebo or no treatment | RR 5.5 [1.33, 22.8] | 3 studies · 1183 participants | Moderate Downgraded: risk of bias |
Stroke Dofetilide vs placebo or no treatment | no estimate extracted | NR | No studies |
Recurrence of atrial fibrillation Dofetilide vs placebo or no treatment | RR 0.72 [0.61, 0.85] | 3 studies · 1183 participants | Moderate Downgraded: risk of bias, inconsistency |
Dronedarone compared to placebo or no treatment for maintaining sinus rhythm after cardioversion of atrial fibrillation
Population: adults in sinus rhythm after cardioversion of atrial fibrillation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Dronedarone vs placebo or no treatment | RR 0.86 [0.68, 1.09] | 3 studies · 6071 participants | High |
Withdrawals due to adverse effects Dronedarone vs placebo or no treatment | RR 1.58 [1.34, 1.85] | 3 studies · 6071 participants | Moderate Downgraded: risk of bias |
Proarrhythmia Dronedarone vs placebo or no treatment | RR 1.95 [0.77, 4.98] | 2 studies · 5872 participants | Moderate Downgraded: inconsistency |
Stroke Dronedarone vs placebo or no treatment | RR 0.66 [0.47, 0.95] | 2 studies · 5872 participants | High |
Recurrence of atrial fibrillation Dronedarone vs placebo or no treatment | RR 0.85 [0.8, 0.91] | 2 studies · 1443 participants | Moderate Downgraded: risk of bias |
Sotalol compared to placebo or no treatment for maintaining sinus rhythm after cardioversion of atrial fibrillation
Population: adults in sinus rhythm after cardioversion of atrial fibrillation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Sotalol vs placebo or no treatment | RR 2.23 [1.03, 4.81] | 5 studies · 1882 participants | High |
Withdrawals due to adverse effects Sotalol vs placebo or no treatment | RR 1.95 [1.23, 3.11] | 12 studies · 2688 participants | Moderate Downgraded: risk of bias, inconsistency, publication bias |
Proarrhythmia Sotalol vs placebo or no treatment | RR 3.55 [2.16, 5.83] | 12 studies · 2989 participants | Moderate Downgraded: risk of bias, publication bias |
Stroke Sotalol vs placebo or no treatment | RR 1.47 [0.48, 4.51] | 3 studies · 1161 participants | Moderate Downgraded: imprecision |
Recurrence of atrial fibrillation Sotalol vs placebo or no treatment | RR 0.83 [0.8, 0.87] | 14 studies · 3179 participants | High |