The efficacy and safety of amiodarone combined with beta-blockers in the maintenance of sinus rhythm for atrial fibrillation

Abstract

Background: The high recurrence rate of atrial fibrillation (AF) after recovering sinus rhythm has always been a clinical problem. Despite the established and widespread use of antiarrhythmic drugs, which one is better for maintaining sinus rhythm is still controversial. This study aims to summarize the randomized controlled trials (RCTs) of amiodarone combined with beta blockers to maintain sinus rhythm in AF, and to determine an effective and safe intervention for the prevention of AF recurrence through network meta-analysis (NMA). Methods and analysis: A comprehensive search of the RCTs comparing amiodarone with different beta-blockers to maintain sinus rhythm of AF patients will be conducted from the inception to December 2019 in the Cochrane Library, PubMed, Web of Science, EMBASE, Chinese Biomedical Literature Database (SinoMed), Chinese National Knowledge Infrastructure (CNKI), and WanFang database. The primary outcomes will be the recurrence of AF and frequency of embolization complications. The secondary outcomes will be the symptom improvements and adverse events. Risk of bias assessment of the included RCTs will be conducted according to the Cochrane collaboration's risk of bias tool. Pairwise meta-analyses and Bayesian network meta-analyses will be performed for all related outcome measures. GRADE will be used to evaluate the quality of evidence. Results: The results of this NMA will be published in a peer-reviewed journal. Conclusion: This NMA may provide more recommendations for patients and researchers, such as which treatment is better for a particular case of AF, and what may be the hotspots for the future studies. PROSPERO registration number: The protocol for this NMA has been registered on PROSPERO under the number CRD42020164438.

Amiodarone and β‐blocker combination therapy versus β‐blocker monotherapy for ICD shock prevention: A meta‐analysis

“…Amiodarone is a commonly used antiarrhythmic drug with the ability to effectively reduce episodes of arrhythmias and therefore hypothetically, ICD shocks 8 . In patients with multiple cardiovascular comorbidities, amiodarone is often prescribed alongside a BB 9 . In 2006, Connolly et al.…”

“…8 In patients with multiple cardiovascular comorbidities, amiodarone is often prescribed alongside a BB. 9 In 2006, Connolly et al conducted the OPTIC study which was the first and only randomized controlled trial (RCT) to date comparing shock rates in patients with an ICD on BB monotherapy versus amiodarone and BB combined therapy. 10 Since then, additional observational studies have assessed the ICD shock rate of BB monotherapy against amiodarone and BB combination therapy and yielded mixed results.…”