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Cardiovascular Drugs and Therapy
Published in: Cardiovascular Drugs and Therapy 6/2022

25-01-2022 | Atrial Fibrillation | Letter to the Editor

Reassessment of Confidence in a Network Meta-analysis of Antidysrhythmic Drugs for Atrial Fibrillation Cardioversion

Authors: Ian S. deSouza, Robert Allen, Pragati Shrestha

Published in: Cardiovascular Drugs and Therapy | Issue 6/2022

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Excerpt

We read with interest the network meta-analysis (NMA) by Tsiachris et al. [1] that sought to compare and rank antidysrhythmic drugs for cardioversion of paroxysmal atrial fibrillation (AF). We congratulate the group for such an undertaking but also feel compelled to discuss additional limitations. To improve the power of their analyses, Tsiachris et al. [1] analyzed data from studies that enrolled patients with AF duration up to 24 h, 48 h, 72 h, and 7 days. Indeed, the NMA generated some effect estimates with narrow confidence intervals but at a cost: potential network intransitivity and confidence in those estimates. …
Literature
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Tsiachris D, Doundoulakis I, Pagkalidou E, et al. Pharmacologic cardioversion in patients with paroxysmal atrial fibrillation: a network meta-analysis. Cardiovasc Drugs Ther. 2021;35:293–308.CrossRefPubMed
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Roy D, Pratt CM, Torp-Pedersen C, et al. Vernakalant hydrochloride for rapid conversion of atrial fibrillation: a phase 3, randomized, placebo-controlled trial. Circulation. 2008;117:1518–25.CrossRefPubMed
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Vardas PE, Kochiadakis GE. Amiodarone for the restoration of sinus rhythm in patients with atrial fibrillation. Card Electrophysiol Rev. 2003;7:297–9.CrossRefPubMed
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Puhan MA, Schunemann HJ, Murad MH, et al. A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ. 2014;349:g5630.CrossRefPubMed
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deSouza IS, Tadrous M, Sexton T, Benabbas R, Carmelli G, Sinert R. Pharmacologic cardioversion of recent-onset atrial fibrillation and flutter in the emergency department: a systematic review and network meta-analysis. Ann Emerg Med. 2020;76:14–30.CrossRefPubMed
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Nikolakopoulou A, Higgins JPT, Papakonstantinou T, et al. CINeMA: an approach for assessing confidence in the results of a network meta-analysis. PLoS Med. 2020;17:e1003082.CrossRefPubMedPubMedCentral
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Pohjantahti-Maaroos H, Hyppola H, Lekkala M, Sinisalo E, Heikkola A, Hartikainen J. Intravenous vernakalant in comparison with intravenous flecainide in the cardioversion of recent-onset atrial fibrillation. Eur Heart J Acute Cardiovasc Care. 2019;8:114–20.CrossRefPubMed
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Vogiatzis I, Papavasiliou E, Dapcevitch I, Pittas S, Koulouris E. Vernakalant versus ibutilide for immediate conversion of recent-onset atrial fibrillation. Hippokratia. 2017;21:67–73.PubMedPubMedCentral
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Metadata
Title
Reassessment of Confidence in a Network Meta-analysis of Antidysrhythmic Drugs for Atrial Fibrillation Cardioversion
Authors
Ian S. deSouza
Robert Allen
Pragati Shrestha
Publication date
25-01-2022
Publisher
Springer US
Published in
Cardiovascular Drugs and Therapy / Issue 6/2022
Print ISSN: 0920-3206
Electronic ISSN: 1573-7241
DOI
https://doi.org/10.1007/s10557-022-07318-y

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