{"id":"86b4a76f45ce","type":"article","url":"https://hartvaat.nl/2021/08/06/orale-antiaritmica-voor-cardioversie-van-recent-onset-af-netwerkmeta-analyse/","title":"Orale antiaritmica voor cardioversie van recent-onset AF: netwerkmeta-analyse","title_en":"Single-dose oral anti-arrhythmic drugs for cardioversion of recent-onset atrial fibrillation: a systematic review and network meta-analysis of randomized controlled trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euab014","source_url":"https://doi.org/10.1093/europace/euab014","authors":["Omar A Ibrahim","Emilie P Belley-Côté","Kevin J Um","Adrian Baranchuk","Alexander P Benz","Shreyash Dalmia","Chang N Wang","Waleed Alhazzani","David Conen","P J Devereaux","Richard P Whitlock","Jeff S Healey","William F McIntyre"],"significance":6,"published":"2021-08-06","source_date":"2021-08-06","image":"","kennis":[],"congress":"","summary_en":"This network meta-analysis of single-dose oral antiarrhythmic drugs for recent-onset AF cardioversion identified the most effective agents and their relative efficacy, informing the pill-in-the-pocket approach to acute rhythm management.","created":"2026-07-03T10:29:20Z","updated":"2026-07-03T13:28:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Netwerkmeta-analyse van orale eenmaal-dosis antiaritmica voor cardioversie van recent-onset AF.","abstract_original":"AIMS: Single oral dose anti-arrhythmic drugs (AADs) are used to cardiovert recent-onset atrial fibrillation (AF); however, the optimal agent is uncertain. METHODS: We performed a systematic review and network meta-analysis of randomized trials testing single oral dose AADs vs. any comparator to cardiovert AF <7 days duration. We searched MEDLINE, Embase, and CENTRAL to April 2020. The primary outcome was successful cardioversion at timepoint nearest 8 h after administration. RESULTS: From 12 712 citations, 22 trials (2320 patients) were included. Thirteen trials included patients with some degree of heart failure; 19 included patients with some degree of ischaemic heart disease vs. placebo or rate-control (32% success) at 8 h, flecainide [73%, network odds ratio (OR) 7.6, 95% credible interval (CrI) 4.4-14.0], propafenone (70%, OR 4.6, CrI 2.9-7.3), and pilsicainide (59%, OR 10.0, CrI 1.8-69.0), but not amiodarone (28%, OR 1.0, CrI 0.4-2.8) were superior. Flecainide (OR 7.5, CrI 2.6-24.0) and propafenone (OR 4.5, CrI 1.6-13.0) were superior to amiodarone; propafenone vs. flecainide did not statistically differ (OR 0.6, CrI 0.3-1.1). At longest follow-up, amiodarone was superior to placebo (OR 11.0, CrI 3.2-41.0), flecainide vs. amiodarone (OR 0.79, CrI 0.19-3.1), and propafenone vs. amiodarone (OR 0.36, CrI 0.092-1.4) were not statistically different, and flecainide was superior to propafenone (OR 2.2, CrI 1.1-4.8). Atrial and ventricular tachyarrhythmias, bradyarrhythmias, and hypotension were rare with PO AADs. CONCLUSION: Single oral dose Class 1C AADs are effective and safe for cardioversion of recent-onset AF. Flecainide may be superior to propafenone. Amiodarone is a slower acting alternative."}