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W F McIntyre, A K Bhatnagar, P Wang, J A Gordon, A Baranchuk, J S Healey, R P Whitlock, E P Belley-Cote, MINION-CIA, P2300
Vernakalant for cardioversion of recent-onset atrial fibrillation: a systematic review and meta-analysis, European Heart Journal, Volume 39, Issue suppl_1, August 2018, ehy565.P2300, https://doi.org/10.1093/eurheartj/ehy565.P2300Close - Share Icon Share
Extract
Background: Vernakalant is a rapid-acting, atrial-selective anti-arrhythmic agent that has been approved for the pharmacological cardioversion of recent-onset atrial fibrillation (AF). Recently published clinical trials have provided new information on the efficacy and safety of this agent. Our objective was to determine if the rates of cardioversion within 90 minutes are different in patients with recent-onset AF who are treated with vernakalant as compared to placebo or active comparator.
Methods: We searched MEDLINE, EMBASE and CENTRAL (inception to January 2018). We included randomized controlled trials comparing vernakalant with active medications or with placebo in patients with AF of onset within 7 days or less. We abstracted data and assessed the risk of bias in each study independently and in duplicate. We used a random-effects model to combine quantitative data. Quality of evidence was rated using GRADE.
Results: From 414 total citations, we identified 9 trials comparing a total of 1314 patients. Six trials compared vernakalant to placebo, 2 trials compared vernakalant to ibutilide and 1 trial compared vernakalant to amiodarone. We found significant methodological bias in 4 of 9 trials (1 with pseudo-randomization, 2 with early termination, 1 with violation of the intention-to-treat principle). Visual inspection of funnel plots was suggestive of publication bias. Overall, vernakalant significantly increased the rate of conversion to sinus rhythm within 90 minutes (RR 5.23; 95% CI 2.25–12.15, I2 test for heterogeneity = 93%). We performed several pre-defined sensitivity analyses. In studies at low risk of bias, the rate of cardioversion was significantly increased with vernakalant (RR 5.98; 95% CI 1.91–18.69, I2=92%). In studies where it was compared to placebo, vernakalant was more effective (RR 7.58 95% CI; 3.75–15.31, I2=58%). However, when vernakalant was compared to an active drug, there was no clear evidence of difference in effect (RR 2.40; 95% CI 0.76–7.58, I2=94). Overall, we judged the quality of evidence for efficacy to be low based on inconsistency and suspected publication bias.
