PRE-TREATMENT WITH AMIODARONE FOR ELECTIVE ELECTRICAL CARDIOVERSION OF ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Clinicians frequently pre-treat patients with amiodarone to increase the efficacy of electrical cardioversion for atrial fibrillation (AF). However, the precise effects on conversion efficacy and sinus rhythm maintenance are not known. We conducted a systematic review and meta-analysis of trials comparing pre-treatment before electrical cardioversion with amiodarone versus no therapy on (1) acute restoration and (2) maintenance of sinus rhythm after one year. We searched MEDLINE and EMBASE from inception to June 2017 for randomized controlled trials (RCTs). We evaluated the risk of bias for individual studies with the Cochrane tool and overall quality of evidence with the GRADE framework. We identified eight eligible studies (n=991). Five studies were deemed to have unclear or high risk of selection bias. We found the evidence to be of high quality based on GRADE. Pre-treatment with amiodarone (200-800 mg daily in divided doses for 1-6 weeks) was associated with higher rates of acute restoration (RR 1.22, 95% CI [1.07, 1.39], p=0.004, I2=65%) and maintenance of sinus rhythm over 13 months (RR 4.39, 95% CI [2.99, 6.45], p<0.001, I2=0%). The effects of amiodarone for acute restoration were maintained when considering only studies at low risk of bias (RR 1.22, 95% CI [1.10, 1.36], P<0.001, I2=0%). Adverse effects were typically non-serious, occurring in 3.4% (6/174) of subjects receiving amiodarone. High-quality evidence demonstrated that pre-treatment with amiodarone improved the restoration and maintenance of sinus rhythm after electrical cardioversion of AF. Short-term amiodarone was well-tolerated.