title: Efficacy and safety in pharmacological cardioversion of recent-onset atrial fibrillation: a propensity score matching to compare amiodarone vs class IC antiarrhythmic drugs.
abstract: The acute management of recent-onset (<48 h) atrial fibrillation (AF) is still debated. Aim of our study was to compare efficacy and safety of intravenously administered class IC antidysrhythmic agents vs amiodarone in a propensity score matched series of patients acutely treated for AF in the emergency department. During a 3-year period, we retrospectively evaluated all episodes of recent-onset (<48 h) AF pharmacologically treated for sinus rhythm restoration in the emergency department. By means of a propensity score matching considering the main statistically different covariates, we selected two accurately matched treatment groups. We analysed the differences between amiodarone and class IC group in terms of efficacy and safety that is conversion to sinus rhythm rates within 12 and 48 h after starting treatment, time to conversion, and adverse drug effects. An overall number of 817 episodes of recent-onset AF were collected (amiodarone group = 406, class IC group = 411). After matching, we obtained 358 episodes equally divided (amiodarone group = 179 and class IC group = 179). Conversion rates within 12 h were 139 (53.1 %) in amiodarone group and 95 (72.6 %) in class IC group (p < 0.05). Median time for cardioversion was 420 min (331.6-508.3 CI 95 %) in amiodarone and 55 min (44.9-65.1 CI 95 %) in class IC group (p < 0.05). The incidence of adverse events in both groups was very low and equally distributed (p = ns). Intravenously administration of class IC agents, when compared with amiodarone, proved to be more rapid and effective, and equally safe in the acute management of recent-onset AF.
authors.affiliation: Emergency and Intensive Care Department, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy. antonio.bonora@ospedaleuniverona.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bonora
authors.affiliation: Postgraduate School of Emergency Medicine, University of Verona, Piazzale L.A. Scuro, 10, Verona, 37134, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Turcato
authors.affiliation: Department of Cardiology, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Franchi
authors.affiliation: Postgraduate School of Emergency Medicine, University of Verona, Piazzale L.A. Scuro, 10, Verona, 37134, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Taioli
authors.affiliation: Emergency and Intensive Care Department, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Dilda
authors.affiliation: Emergency and Intensive Care Department, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy.
authors.forename: Germana
authors.initials: G
authors.lastname: Zerman
authors.affiliation: Emergency and Intensive Care Department, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Maccagnani
authors.affiliation: Emergency and Intensive Care Department, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Pistorelli
authors.affiliation: Department of Internal Medicine, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy.
authors.forename: Oliviero
authors.initials: O
authors.lastname: Olivieri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000009:adverse effects* / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004554:Electric Countershock / Q000379:methods / Q000592:standards*; D005260:Female; D005424:Flecainide / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069437:Pharmacological Phenomena; D011405:Propafenone / Q000009:adverse effects / Q000627:therapeutic use; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D011405:Propafenone; D005424:Flecainide; D000638:Amiodarone
keywords: Pharmacological rhythm control; Propensity score matching; Recent-onset atrial fibrillation