title: Meta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation.
abstract: OBJECTIVE
  To conduct a meta-analysis of randomised controlled trials to estimate the effectiveness of antiarrhythmic drugs at promoting sinus rhythm in patients with atrial fibrillation.
  
  
  METHODS
  Articles were identified by using a comprehensive search of English language papers indexed in Medline from 1966 to August 2001. For the outcomes of sinus rhythm and death, a random effects model was used to model repeated assessments within a study at different time points.
  
  
  METHODS
  Emergency departments and ambulatory clinics.
  
  
  METHODS
  Patients with atrial fibrillation.
  
  
  METHODS
  Antiarrhythmic agents grouped according to their Vaughan-Williams class.
  
  
  METHODS
  Sinus rhythm and mortality.
  
  
  RESULTS
  91 articles met a priori criteria for inclusion in the analysis. Median duration of follow up was one day (range 0.04-1096, mean (SD) 46 (136) days). The median proportion of patients in sinus rhythm at follow up was 55% (range 0-100%) and 32% (range 0-90%) receiving active treatment and placebo, respectively. Median survival was 99% (range 55-100%) and 99% (range 55-100%). Compared with placebo, the following drug classes were associated with increased sinus rhythm at follow up: IA (treatment difference 21.5%, 95% confidence interval (CI) 16.3% to 26.8%); IC (treatment difference 33.1%, 95% CI 23.3% to 42.9%); and III (treatment difference 17.4%, 95% CI 11.5% to 23.3%). Class IC drugs were associated with increased sinus rhythm at follow up compared with class IV drugs (treatment difference 43.2%, 95% CI 11.5% to 75.0%). There was no significant difference in mortality between any drug classes.
  
  
  CONCLUSIONS
  Class IA, IC, and III drugs are associated with increased sinus rhythm at follow up compared with placebo. It is unclear whether any antiarrhythmic drug class is associated with increased or decreased mortality.
authors: Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada. grahamnichol@earthlink.net
authors: G
authors: G
authors: Nichol
authors: F
authors: F
authors: McAlister
authors: B
authors: B
authors: Pham
authors: A
authors: A
authors: Laupacis
authors: B
authors: B
authors: Shea
authors: M
authors: M
authors: Green
authors: A
authors: A
authors: Tang
authors: G
authors: G
authors: Wells
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents