title: Efficacy of Intravenous and Oral Sotalol in Pharmacologic Conversion of Atrial Fibrillation: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  The role of sotalol is well established for the maintenance of sinus rhythm after successful conversion of atrial fibrillation (AF). However, its role in pharmacologic conversion of AF is poorly defined. The purpose of this study is to compare the efficacy of sotalol to that of other antiarrhythmic agents for AF conversion.
  
  
  METHODS
  Standard methods of meta-analysis were employed. Full-text publications of clinical trials in English that compared the efficacy of sotalol to that of other antiarrhythmics or placebo/no treatment were eligible for inclusion.
  
  
  RESULTS
  A systematic review revealed 10 eligible publications. Sotalol was superior to placebo and/or no antiarrhythmic therapy in AF conversion, with a relative success of 24 (95% CI 4.7-119, p < 0.001). Sotalol was not significantly different from class IA antiarrhythmic drugs. Similarly, sotalol was not different from class IC antiarrhythmic drugs or amiodarone in terms of conversion efficacy. In one study, sotalol was less effective than high-dose ibutilide (2 mg), with a relative success of 0.248 (95% CI 0.128-0.481, p < 0.001). Ibutilide caused more proarrhythmia.
  
  
  CONCLUSIONS
  Sotalol is as effective as class IA and class IC antiarrhythmic agents, and it is also as effective as amiodarone for pharmacologic conversion of AF. Only ibutilide at a high dose showed a greater conversion rate of AF.
authors.affiliation: Cardiovascular Research Center, Massachusetts General Hospital, Boston, Mass., USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Milan
authors.forename: J Philip
authors.initials: JP
authors.lastname: Saul
authors.forename: John C
authors.initials: JC
authors.lastname: Somberg
authors.forename: Janos
authors.initials: J
authors.lastname: Molnar
mesh_terms: D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D013015:Sotalol / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use; D013810:Therapeutic Equivalency
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D013449:Sulfonamides; C067192:ibutilide; D013015:Sotalol; D000638:Amiodarone