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Meta-Analysis
. 2019 Aug 1;21(8):1159-1166.
doi: 10.1093/europace/euz175.

Vernakalant for cardioversion of recent-onset atrial fibrillation: a systematic review and meta-analysis

William F McIntyre  1 , Jeff S Healey  1 , Akash K Bhatnagar  1 , Patrick Wang  1 , Jacob A Gordon  1 , Adrian Baranchuk  2 , Bishoy Deif  1 , Richard P Whitlock  1 , Émilie P Belley-Côté  1
Affiliations
Meta-Analysis

Vernakalant for cardioversion of recent-onset atrial fibrillation: a systematic review and meta-analysis

William F McIntyre et al. Europace. .

Abstract

Aims: To evaluate the efficacy and safety of vernakalant for the cardioversion of atrial fibrillation (AF).

Methods and results: We reviewed the literature for randomized trials that compared vernakalant to another drug or placebo in patients with AF of onset ≤7 days. We used a random-effects model to combine quantitative data and rated the quality of evidence using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation). From 441 total citations in MEDLINE, EMBASE, and CENTRAL (December 2018), we identified nine trials evaluating 1358 participants. Six trials compared vernakalant to placebo, two trials compared vernakalant to ibutilide, and one trial compared vernakalant to amiodarone. We found significant methodological bias in four trials. For conversion within 90 min, vernakalant was superior to placebo [50% conversion, risk ratio (RR) 5.15; 95% confidence interval (CI); 2.24-11.84, I2 = 91%], whereas we found no significant difference in conversion when vernakalant was compared with an active drug (56% vs. 24% conversion, RR 2.40; 95% CI 0.76-7.58, I2 = 94). Sinus rhythm was maintained at 24 h in 85% (95% CI 80-88%) of patients who converted acutely with vernakalant. Overall, we judged the quality of evidence for efficacy to be low based on inconsistency and suspected publication bias. There was no significant difference in the risk of significant adverse events between vernakalant and comparator (RR 0.95; 95% CI 0.70-1.28, I2 = 0, moderate quality evidence). Vernakalant is safe and effective for rapid and durable restoration of sinus rhythm in patients with recent-onset AF.

Conclusion: Vernakalant should be a first line option for the pharmacological cardioversion of patients with haemodynamically stable recent-onset AF without severe structural heart disease.

Keywords: Amiodarone; Atrial fibrillation; Cardioversion; Ibutilide; Meta-analysis; Systematic review; Vernakalant.

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Figures

Figure 1
Figure 1
Study selection diagram for trials comparing vernakalant to placebo or active drug in patients with recent-onset atrial fibrillation.
Figure 2
Figure 2
(A) Relative risks of conversion within 90 min in trials comparing vernakalant to comparator in patients with recent-onset atrial fibrillation. (B) Relative risks of conversion within 90 min in trials comparing vernakalant to comparator in patients with recent-onset atrial fibrillation: subgrouped according to whether participants received placebo or active drug.
Figure 3
Figure 3
(A) Relative risks of sustained conversion at 24 h in trials comparing vernakalant to comparator in patients with recent-onset atrial fibrillation: all participants. (B) Relative risks of sustained conversion at 24 h in trials comparing vernakalant to comparator in patients with recent-onset atrial fibrillation: participants who converted acutely.
Figure 4
Figure 4
Relative risks of significant adverse events in trials comparing vernakalant to comparator in patients with recent-onset atrial fibrillation.
See this image and copyright information in PMC

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