Dimitris Tsiachris1,2, Ioannis Doundoulakis3,4, Panagiotis Tsioufis4, Eirini Pagkalidou5, Christos-Konstantinos Antoniou3, Stefanos M Zafeiropoulos6,7, Konstantinos A Gatzoulis4, Konstantinos Tsioufis4, Christodoulos Stefanadis3,8. 1. Athens Medical Center, Athens Heart Center, Distomou 5-7, 15125, Athens, Greece. dtsiachris@yahoo.com. 2. First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece. dtsiachris@yahoo.com. 3. Athens Medical Center, Athens Heart Center, Distomou 5-7, 15125, Athens, Greece. 4. First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece. 5. Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece. 6. Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY, USA. 7. Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, USA. 8. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
Abstract
PURPOSE: The objective of the present systematic review was to compare the effectiveness and safety of class Ic agents for cardioversion of paroxysmal atrial fibrillation (AF), in patients with and without structural heart disease (SHD). METHODS: We focused on RCTs enrolling at least 50 adult patients with electrocardiogram-documented paroxysmal AF that compared either two pharmacological class Ic cardioversion agents (flecainide, propafenone), regardless of study design (parallel or crossover). We searched MEDLINE and the Cochrane Central Register of Controlled Trials. Initial search was performed from inception to 15 July 2021 with no language restrictions. RESULTS: Intravenous flecainide is the most effective option for pharmacologic cardioversion of AF since only 2 patients need to be treated in order to cardiovert one more within 4 h. Most importantly, class Ic agents appear to be safe in the context of pharmacologic cardioversion of AF irrespective of the presence of SHD, pointing towards a possible reappraisal of the role in this setting. CONCLUSION: We suggest that class Ic agents (with flecainide appearing to be more effective) should be used for pharmacologic cardioversion in stable AF patients presenting in emergency department with unknown medical history, after excluding severe cardiac disease through a bedside examination. REGISTRATION NUMBER (DOI): Available in https://osf.io/apwt7/ , https://doi.org/10.17605/OSF.IO/APWT7.
PURPOSE: The objective of the present systematic review was to compare the effectiveness and safety of class Ic agents for cardioversion of paroxysmal atrial fibrillation (AF), in patients with and without structural heart disease (SHD). METHODS: We focused on RCTs enrolling at least 50 adult patients with electrocardiogram-documented paroxysmal AF that compared either two pharmacological class Ic cardioversion agents (flecainide, propafenone), regardless of study design (parallel or crossover). We searched MEDLINE and the Cochrane Central Register of Controlled Trials. Initial search was performed from inception to 15 July 2021 with no language restrictions. RESULTS: Intravenous flecainide is the most effective option for pharmacologic cardioversion of AF since only 2 patients need to be treated in order to cardiovert one more within 4 h. Most importantly, class Ic agents appear to be safe in the context of pharmacologic cardioversion of AF irrespective of the presence of SHD, pointing towards a possible reappraisal of the role in this setting. CONCLUSION: We suggest that class Ic agents (with flecainide appearing to be more effective) should be used for pharmacologic cardioversion in stable AF patients presenting in emergency department with unknown medical history, after excluding severe cardiac disease through a bedside examination. REGISTRATION NUMBER (DOI): Available in https://osf.io/apwt7/ , https://doi.org/10.17605/OSF.IO/APWT7.
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