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Wilson H, Patton D, Moore Z, O'Connor T, Nugent L. Comparison of dronedarone vs. flecainide in the maintenance of sinus rhythm, following electrocardioversion in adults with persistent atrial fibrillation: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2021; 7:363-372. [PMID: 32163173 DOI: 10.1093/ehjcvp/pvaa018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/24/2020] [Accepted: 03/05/2020] [Indexed: 11/13/2022]
Abstract
AIMS To compare flecainide and dronedarone for sinus rhythm (SR) maintenance following electrocardioversion of persistent atrial fibrillation (AF), in patients with minimal or no structural heart disease. METHODS AND RESULTS A systematic search of publications using EMBASE, CENTRAL, CINAHL, and MEDLINE (1989-2019), identified a total of 595 articles. No limitations were applied. Nine articles met the inclusion criteria [five randomized controlled trials (RCTs) and four cohort studies], encompassing 1349 persistent AF candidates. Two retrospective studies compared flecainide with dronedarone, indicating a 6% reduced risk of AF recurrence with flecainide; however, results were not statistically significant [risk ratio (RR) 0.94, 95% confidence interval (CI) 0.71-1.24; P = 0.66]. One RCT compared dronedarone to placebo, demonstrating a 28% reduced risk of AF recurrence at 6 months (RR 0.72, 95% CI 0.58-0.90; P = 0.004). Two RCTs compare flecainide to placebo, when a 16% decreased risk of AF recurrence at 6-12 months was indicated; however, these results were not statistically significant (RR 0.84, 95% CI 0.66-1.07; P = 0.16). Within a 6- to 12-month follow-up period, a combined recurrence rate of AF was examined, in which flecainide and dronedarone maintained SR in 50% and 42%, respectively. Four articles satisfied quality appraisal, one of which focused on flecainide data. CONCLUSION Dronedarone and flecainide displayed similar efficacy in maintaining SR in patients following electrocardioversion for persistent AF. The SR maintenance was numerically but not statistically significant in the flecainide group. Side effects uncovered similar pro-arrhythmic activity. However, in light of the deficiency of volume and quality of available evidence, the writer acknowledges the requirement for future research.
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Affiliation(s)
- Hannah Wilson
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin D02 YN77, Ireland.,Mater Private Hospital, Eccles St, Northside, Dublin D07 WKW8, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin D02 YN77, Ireland.,Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.,Fakeeh College of Health Sciences, Abdul Wahab Naib Al Haram, Al-Hamra'a, Jeddah 23323, Saudi Arabia
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin D02 YN77, Ireland.,Fakeeh College of Health Sciences, Abdul Wahab Naib Al Haram, Al-Hamra'a, Jeddah 23323, Saudi Arabia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Wellington Rd, Clayton VIC 3800, Melbourne, Australia.,Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, Gent 9000, Belgium.,Lida Institute, 1788 Cheting Hwy, Songjiang District, Shanghai, China.,University of Wales, Kind Edward VII Ave, Cardiff CF10 3NS, UK
| | - Tom O'Connor
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin D02 YN77, Ireland.,Fakeeh College of Health Sciences, Abdul Wahab Naib Al Haram, Al-Hamra'a, Jeddah 23323, Saudi Arabia.,Lida Institute, 1788 Cheting Hwy, Songjiang District, Shanghai, China
| | - Linda Nugent
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin D02 YN77, Ireland.,Fakeeh College of Health Sciences, Abdul Wahab Naib Al Haram, Al-Hamra'a, Jeddah 23323, Saudi Arabia
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