Objective To assess the effectiveness and safety of ibutilide and propafenone in the treatment of atrial fibrillation (AF) and atrial flutter (AFL). Methods All randomized controlled trials (RCTs) on ibutilide and propafenone for AF and AFL were retrieved from databases including CBM (1978 to October 2011), VIP (1989 to October 2011), CNKI (1994 to October 2011) and WanFang Data (1998 to October 2011). The quality of included RCTs was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions Version 4.2.6, and the Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results 16 RCTs involving 1 196 patients were included. Results of meta-analysis showed that: a) About effectiveness: compare with propafenone applied as routine therapy, ibutilide was more effective in the total conversion rate of AF and AFL with regards to the time of 0~90 min, 0~4 hour and 0~24 hour with significant differences (OR=3.32, OR=2.69, OR=3.08, respectively, Plt;0.000 1); In subgroup analysis, a significant difference was found in the conversion rate of AF or AFL in the time of 0~90min. In the time duration for conversion, there was a significant difference (MD=–25.12, 95%CI –30.43 to –19.82, Plt;0.000 01); and b) About the safety: there was a significant difference between the two groups in the incidence of cardiac arrhythmia (OR=3.15, 95%CI 1.97 to 5.05, Plt;0.000 01) and other adverse effects (OR=0.16, 95%CI 0.08 to 0.33, Plt;0.000 01). Conclusion Current evidence shows that ibutilide is more effective than propafenone in converting AF or AFL, with a higher incidence of cardiac arrhythmia than propafenone. However, more high-quality, large-scale RCTs are still needed to confirm the effectiveness and safety of ibutilide and propafenone for AF/AFL because of the limitation of the methodological quality and sample size of the included studies.