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Cardiology 2017;136:52-60
(DOI:10.1159/000447237)

Efficacy of Intravenous and Oral Sotalol in Pharmacologic Conversion of Atrial Fibrillation: A Systematic Review and Meta-Analysis

Milan D.J.a · Saul J.P.b · Somberg J.C.c · Molnar J.d, e

Author affiliations

aCardiovascular Research Center, Massachusetts General Hospital, Boston, Mass., bDepartment of Pediatrics, School of Medicine, West Virginia University, Morgantown, W. Va., cDepartment of Medicine and Pharmacology, Rush University, Chicago, Ill., dAmerican Institute of Therapeutics, Lake Bluff, Ill., and eDepartment of Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Ill., USA

Corresponding Author

Janos Molnar, MD

American Institute of Therapeutics

21 N. Skokie Hwy, G-3

Lake Bluff, IL 60044 (USA)

E-Mail Janos.Molnar@rosalindfranklin.edu

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Abstract

Objectives: The role of sotalol is well established for the maintenance of sinus rhythm after successful conversion of atrial fibrillation (AF). However, its role in pharmacologic conversion of AF is poorly defined. The purpose of this study is to compare the efficacy of sotalol to that of other antiarrhythmic agents for AF conversion. Methods: Standard methods of meta-analysis were employed. Full-text publications of clinical trials in English that compared the efficacy of sotalol to that of other antiarrhythmics or placebo/no treatment were eligible for inclusion. Results: A systematic review revealed 10 eligible publications. Sotalol was superior to placebo and/or no antiarrhythmic therapy in AF conversion, with a relative success of 24 (95% CI 4.7-119, p < 0.001). Sotalol was not significantly different from class IA antiarrhythmic drugs. Similarly, sotalol was not different from class IC antiarrhythmic drugs or amiodarone in terms of conversion efficacy. In one study, sotalol was less effective than high-dose ibutilide (2 mg), with a relative success of 0.248 (95% CI 0.128-0.481, p < 0.001). Ibutilide caused more proarrhythmia. Conclusions: Sotalol is as effective as class IA and class IC antiarrhythmic agents, and it is also as effective as amiodarone for pharmacologic conversion of AF. Only ibutilide at a high dose showed a greater conversion rate of AF.

© 2016 S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Original Research

Received: May 26, 2016
Accepted: May 26, 2016
Published online: August 24, 2016

Number of Print Pages: 9
Number of Figures: 5
Number of Tables: 1

ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)

For additional information: https://www.karger.com/CRD