title: Interventions for the treatment of atrial fibrillation: a systematic literature review and meta-analysis.
abstract: BACKGROUND
  To perform a systematic review/meta-analysis evaluating the efficacy and safety of anti-arrhythmic drugs (AADs) in the treatment of atrial fibrillation (AF).
  
  
  METHODS
  Database searches (accessed April 2009) were conducted to identify randomised controlled trials (RCTs). Comparators of interest included all AADs, rate/rhythm strategies or catheter ablation in comparison with AADs. Primary AADs of interest were restricted to Class IC (flecainide and propafenone) and Class III (amiodarone, dofetilide, dronedarone and sotalol). Data were analysed on an intention-to-treat basis and meta-analysis performed using the Peto odds ratio (OR)/fixed-effect model.
  
  
  RESULTS
  113 publications met inclusion criteria. Of these, 74 publications considered an AAD of primary interest. The odds of AF recurrence were generally significantly lower with all active treatments versus non-active control. Dronedarone was the only AAD to show a (non-significant) trend towards reducing the odds of mortality with a narrow CI (OR 0.85 [0.66, 1.09]). Withdrawals due to adverse events (AEs), incidence of serious adverse events (SAEs) and treatment discontinuation were increased following active treatment compared with control, with few significant differences reported between active treatments. Data for other morbidity outcomes such as cardiovascular mortality, hospitalizations or persistence/compliance and health-related quality of life (HRQoL) were limited and meta-analyses were not possible for these outcomes.
  
  
  CONCLUSIONS
  The current meta-analysis confirms the efficacy of AADs in preventing AF recurrence, although their use is associated with a greater incidence of AEs and treatment discontinuation. Further RCTs are required to establish the benefit of AADs in the management of both morbidity outcomes and HRQoL.
authors.affiliation: University of Washington, Seattle, USA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Orme
authors.forename: Edith
authors.initials: E
authors.lastname: Morais
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Mitchell
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents