Effectiveness and Safety of Ibutilide versus Amiodarone in Cardioversion of Atrial Fibrillation and Atrial Flutter: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

DONG Xiao ¹ , ZHU Sainan ² ,  DING Wenhui ¹

1. Department of Cardiology, the First Hospital of Peking University, Beijing 100034, China; 2. Department of Statistics, the First Hospital of Peking University, Beijing 100034, China;

Corresponding author：

DING Wenhui, Email: dwh_rd@126.com

Keywords：

Ibutilide; Amiodarone; Atrial fibrillation; Atrial flutter; Cardioversion; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20120032

Video：

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Objective 　 To evaluate the therapeutic effectiveness and safety of ibutilide versus amiodarone in the treatment of atrial fibrillation and atrial flutter.
Methods 　 An electronic search in databases including PubMed, Embase, CNKI, WanFang Data, VIP Database, and The Cochrane Library (Issue 2, 2011), published from January 1994 to January 2011,was conducted to include both English and Chinese randomized controlled trials (RCTs) about ibutilide versus amiodarone in treating atrial fibrillation and atrial flutter. Two reviewers independently screened the studies according to the inclusive and exclusive criteria, extracted the data, assessed the methodological quality, and then performed Meta-analysis by using RevMan 5.0 software.
Results 　 Eight RCTs involving 506 patients were finally included. The results of Meta-analysis showed: a) The total effective rate of alleviating atrial fibrillation and atrial flutter in the ibutilide group was superior to that of the amiodarone group (OR=2.27, 95%CI 1.19 to 4.33, P=0.01); b) Four RCTs showed that ibutilide was similar to amiodarone for alleviating atrial fibrillation (OR=1.61, 95%CI 0.96 to 2.71, P=0.07), but the former was superior to the latter for alleviating atrial flutter (OR=8.97, 95%CI 4.51 to 17.84, P lt;0.000 01); c) Five RCTs showed that ibulitide took shorter time to alleviate atrial fibrillation and atrial flutter compared with amiodarone (WMD= –126.55 min, 95%CI –202.35 to –50.76, P=0.001); d) Four RCTs showed that the total adverse effect rates in the two groups had no significant difference (OR=1.13, 95%CI 0.37 to 3.43, P=0.83), but there were more cardiovascular side-effects in the ibutilide group (OR=2.36, 95%CI 1.40 to 4.01, P=0.001).
Conclusion 　 Compared with amiodarone, ibutilide has a higher total effective rate in cardioversion of atrial fibrillation and atrial flutter, and it obviously takes shorter time to alleviate atrial fibrillation and atrial flutter, but there is no significant difference in the cardioversion rate of atrial fibrillation between them. There is no significant difference in total side-effect rates between the two groups, but the cardiovascular adverse reaction in the ibutilide group is significantly higher than that of the amiodarone group. Because of the limited quantity and quality of the included studies, this conclusion has to be further proved by more high-quality RCTs.

Citation： DONG Xiao ,ZHU Sainan,DING Wenhui. Effectiveness and Safety of Ibutilide versus Amiodarone in Cardioversion of Atrial Fibrillation and Atrial Flutter: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(2): 194-200. doi: 10.7507/1672-2531.20120032 Copy

1.	1 Oral H, Ozaydin M, Tada H, et al . Comparison of amiodarone versus ibutilide for the prevention of immediate recurrences of atrial fibrillation during pulmonary vein isolation. Am J Cardiol , 2002, 90(5): 492-495.
2.	Kafkas NV, Patsilinakos SP, Mertzanos GA, et al . Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter. Int J Cardiol , 2007, 118(3): 321-325.
3.	李春岩, 冯择瑞. 伊布利特转复房扑及房颤的临床研究. 黑龙江医学, 2009, 33(10): 732-735.
4.	胡立群, 章琦, 陈莉, 等. 伊布利特转复老年心房颤动的临床研究. 药物治疗学, 2009, 14 (12): 1419-1422.
5.	李飒, 周文燕, 段淑琴, 等. 中西医结合心脑血管病杂志, 2010, 8(7): 873-874.
6.	刘飞, 张烁. 伊布利特转复房扑/房颤的临床观察. 中国医疗前沿, 2010, 5(10): 23.
7.	Tai CT, Chen SA, Feng AN, et al . Electropharmacologic effects of class I and class III antiarrhythmia drugs on typical atrial flutter: insights into the mechanism of termination. Circulation , 1998, 97(19): 1935-1945.
8.	Bernard EO, Schmid ER, Schmidlin D, et al . Ibutilide versus amiodarone in atrial fibrillation: a double-blinded, randomized study. Crit Care Med , 2003, 31(4): 1031-1034.
9.	Kirchhof P, Auricchio A, Bax J, et al . Outcome parameters for trials in atrial fibrillation: executive summary. Eur Heart J , 2007, 28(22): 2803-2817.
10.	Miyasaka Y, Barnes M, Gersh B, et al . Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation , 2006, 114(2): 119-125.
11.	Heeringa J, van der Kuip D, Hofman A, et al . Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J , 2006, 27(8): 949-953.
12.	Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al . ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol , 2003, 42(8): 1493-1531.
13.	Fuster V, Rydén LE, Cannom DS, et al . ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). Eur Heart J , 2006, 27(16): 1979-2030.
14.	Fuster V, Rydén LE, Cannom DS, et al . 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol , 2011, 57(11): 101-198.
15.	Sager PT. New advances in class III antiarrhythmic drug therapy. Curr Opin Cardiol , 2000, 15(1): 41-53.

1. 1 Oral H, Ozaydin M, Tada H, et al . Comparison of amiodarone versus ibutilide for the prevention of immediate recurrences of atrial fibrillation during pulmonary vein isolation. Am J Cardiol , 2002, 90(5): 492-495.
2. Kafkas NV, Patsilinakos SP, Mertzanos GA, et al . Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter. Int J Cardiol , 2007, 118(3): 321-325.
3. 李春岩, 冯择瑞. 伊布利特转复房扑及房颤的临床研究. 黑龙江医学, 2009, 33(10): 732-735.
4. 胡立群, 章琦, 陈莉, 等. 伊布利特转复老年心房颤动的临床研究. 药物治疗学, 2009, 14 (12): 1419-1422.
5. 李飒, 周文燕, 段淑琴, 等. 中西医结合心脑血管病杂志, 2010, 8(7): 873-874.
6. 刘飞, 张烁. 伊布利特转复房扑/房颤的临床观察. 中国医疗前沿, 2010, 5(10): 23.
7. Tai CT, Chen SA, Feng AN, et al . Electropharmacologic effects of class I and class III antiarrhythmia drugs on typical atrial flutter: insights into the mechanism of termination. Circulation , 1998, 97(19): 1935-1945.
8. Bernard EO, Schmid ER, Schmidlin D, et al . Ibutilide versus amiodarone in atrial fibrillation: a double-blinded, randomized study. Crit Care Med , 2003, 31(4): 1031-1034.
9. Kirchhof P, Auricchio A, Bax J, et al . Outcome parameters for trials in atrial fibrillation: executive summary. Eur Heart J , 2007, 28(22): 2803-2817.
10. Miyasaka Y, Barnes M, Gersh B, et al . Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation , 2006, 114(2): 119-125.
11. Heeringa J, van der Kuip D, Hofman A, et al . Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J , 2006, 27(8): 949-953.
12. Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al . ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol , 2003, 42(8): 1493-1531.
13. Fuster V, Rydén LE, Cannom DS, et al . ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). Eur Heart J , 2006, 27(16): 1979-2030.
14. Fuster V, Rydén LE, Cannom DS, et al . 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol , 2011, 57(11): 101-198.
15. Sager PT. New advances in class III antiarrhythmic drug therapy. Curr Opin Cardiol , 2000, 15(1): 41-53.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Ibutilide versus Amiodarone in Cardioversion of Atrial Fibrillation and Atrial Flutter: A Meta-Analysis

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