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Journal of Cardiothoracic Surgery May 2024To evaluate the clinical efficacy and safety of intraoperative intravenous amiodarone for arrhythmia prevention in on-pump coronary artery bypass grafting (CABG)... (Meta-Analysis)
Meta-Analysis Review
The efficacy and safety of intraoperative intravenous amiodarone in patients undergoing on-pump coronary artery bypass grafting surgery: a systemic review and PRISMA-compliant meta-analysis.
BACKGROUND
To evaluate the clinical efficacy and safety of intraoperative intravenous amiodarone for arrhythmia prevention in on-pump coronary artery bypass grafting (CABG) patients.
METHODS
A meta-analysis of randomized controlled trials was conducted. Pubmed, Embase, Cochrane Library, Ovid, China National Knowledge Infrastructure, and the Wan Fang database until July 1th, 2023. The primary outcomes of interest included the incidences of intra- and post-operative atrial fibrillation (POAF), ventricular fibrillation, or any arrhythmia, including atrial fibrillation, ventricular fibrillation, ventricular tachycardia, premature ventricular contraction, and sinus bradycardia. For continuous and dichotomous variables, treatment effects were calculated as the weighted mean difference (WMD)/risk ratio (RR) and 95% confidence interval (CI).
RESULTS
A database search yielded 7 randomized controlled trials including 608 patients, where three studies, including three treatments (amiodarone, lidocaine, and saline), contributed to the clinical outcome of atrial fibrillation, ventricular fibrillation, or any arrhythmia. Meta-analysis demonstrated that amiodarone can significantly reduce the incidence of POAF (RR, 0.39; 95%CI: 0.20, 0.77; P = 0.007, I = 0%) in patients undergoing on-pump CABG; there was no statistically significant influence on intra-operative atrial fibrillation, intra- and post-operative ventricular fibrillation, or any arrhythmia.
CONCLUSIONS
The current study suggests that intraoperative administration of intravenous amiodarone may be safe and effective in preventing POAF in patients undergoing on-pump CABG. More well-designed clinical trials are needed to validate this result.
Topics: Humans; Amiodarone; Coronary Artery Bypass; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Intraoperative Care; Administration, Intravenous; Postoperative Complications; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 38702789
DOI: 10.1186/s13019-024-02732-9 -
Pacing and Clinical Electrophysiology :... Aug 2013We attempted to evaluate if an oral-only regimen was as effective in preventing postoperative atrial fibrillation (POAF) after cardiac surgery, in comparison to a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
We attempted to evaluate if an oral-only regimen was as effective in preventing postoperative atrial fibrillation (POAF) after cardiac surgery, in comparison to a regimen that included intravenous (IV) administration using a network meta-analysis of available data, and also attempted to assess if preoperative administration at least 1 day before surgery was superior to postoperative prophylaxis (at least 1 day after surgery).
METHODS
We searched PubMed, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials' databases for randomized controlled trials conducted between 1990 and 2011 that assessed rates of POAF with amiodarone. Finally an interaction odds ratio was computed to assess the efficacy of an oral-only regimen of amiodarone compared to one including IV administration and to evaluate if preoperative amiodarone was superior to postoperative prophylaxis.
RESULTS
Twenty-three studies (total N = 3,950) were included. Both regimens of amiodarone improved risk of POAF; oral-only risk ratio (RR) was 0.59 (95% confidence interval [CI] 0.49-0.70; P < 0.01) and regimen including IV RR was 0.57 (95% CI 0.43-0.75, P < 0.01). The interaction odds ratio was 1.17 (95% CI 0.72-1.89, P = 0.533). Both preoperative amiodarone (P < 0.01) and postoperative prophylaxis were effective (P = 0.0009), irrespective of duration.
CONCLUSIONS
This systematic review suggests a regimen of both oral-only and one including IV administration, as well pre- and postoperative administration of amiodarone is effective in prevention of POAF after cardiac surgery.
Topics: Administration, Oral; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiac Surgical Procedures; Drug Administration Schedule; Evidence-Based Medicine; Female; Humans; Injections, Intravenous; Internet; Male; Postoperative Care; Postoperative Complications; Premedication; Preoperative Care; Prevalence; Regression Analysis; Risk Assessment; Treatment Outcome
PubMed: 23627761
DOI: 10.1111/pace.12140 -
The Journal of Emergency Medicine Mar 2018Atrial fibrillation (AF) is the most commonly encountered dysrhythmia in the emergency department, and its prevalence is increasing. A substantial proportion of these... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Atrial fibrillation (AF) is the most commonly encountered dysrhythmia in the emergency department, and its prevalence is increasing. A substantial proportion of these patients have recent-onset AF (<48 h). The poor prognosis associated with AF is being increasingly recognized, and there is some evidence for better outcomes in younger patients with recent-onset AF when sinus rhythm is restored. Flecainide is recommended in the latest international guidelines for cardioversion of recent-onset AF, but its safety and efficacy relative to other recommended agents are unclear.
OBJECTIVE
Our aim was to clarify the Level 1 evidence for the use of i.v. flecainide in acute AF.
METHODS
We performed a systematic review and meta-analysis of the literature. Medline, Ovid, Embase, and Cochrane Central databases were searched for relevant studies. Only randomized controlled trials (RCTs) of i.v. flecainide for acute conversion of recent-onset AF were selected for meta-analysis.
RESULTS
Four hundred and three studies were screened, of which 11 RCTs were eligible for meta-analysis. Flecainide had high efficacy for cardioversion within 2 h (number needed to treat [NNT] = 1.8). Efficacy was superior to propafenone, amiodarone, procainamide, ibutilide, and sotalol (NNT = 4.3). There was no statistically significant difference in pro-dysrhythmia compared to these anti-dysrhythmics or placebo.
CONCLUSIONS
Intravenous flecainide cardioversion could be a safe and effective option for emergency physicians to restore sinus rhythm in selected patients with acute AF.
Topics: Administration, Intravenous; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Electric Countershock; Emergency Service, Hospital; Flecainide; Humans; United Kingdom
PubMed: 29269083
DOI: 10.1016/j.jemermed.2017.11.016 -
The Western Journal of Emergency... Jul 2021The benefit of medications used in out-of-hospital, shock-refractory cardiac arrest remains controversial. This study aims to compare the treatment outcomes of... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The benefit of medications used in out-of-hospital, shock-refractory cardiac arrest remains controversial. This study aims to compare the treatment outcomes of medications for out-of-hospital, shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).
METHODS
The inclusion criteria were randomized controlled trials of participants older than eight years old who had atraumatic, out-of-hospital, shock-refractory VF/pVT in which at least one studied group received a medication. We conducted a database search on October 28, 2019, that included PubMed, Scopus, Web of Science, CINAHL Complete, and Cochrane CENTRAL. Citations of relevant meta-analyses were also searched. We performed frequentist network meta-analysis (NMA) to combine the comparisons. The outcomes were analyzed by using odds ratios (OR) and compared to placebo. The primary outcome was survival to hospital discharge. The secondary outcomes included the return of spontaneous circulation (ROSC), survival to hospital admission, and the neurological outcome at discharge. We ranked all outcomes using surface under the cumulative ranking score.
RESULTS
We included 18 studies with 6,582 participants. The NMA of 20 comparisons included 12 medications and placebo. Only norepinephrine showed a significant increase of ROSC (OR = 8.91, 95% confidence interval [CI], 1.88-42.29). Amiodarone significantly improved survival to hospital admission (OR = 1.53, 95% CI, 1.01-2.32). The ROSC and survival-to-hospital admission data were significantly heterogeneous with the I2 of 55.1% and 59.1%, respectively. This NMA satisfied the assumption of transitivity.
CONCLUSION
No medication was associated with improved survival to hospital discharge from out-of-hospital, shock-refractory cardiac arrest. For the secondary outcomes, norepinephrine was associated with improved ROSC and amiodarone was associated with an increased likelihood of survival to hospital admission in the NMA.
Topics: Anti-Arrhythmia Agents; Child; Hospitals; Humans; Network Meta-Analysis; Out-of-Hospital Cardiac Arrest; Randomized Controlled Trials as Topic
PubMed: 35354019
DOI: 10.5811/westjem.2021.2.49590 -
Phytomedicine : International Journal... Jan 2022The combination of antiarrhythmic drugs with traditional Chinese formulas are used treatments for the management of paroxysmal atrial fibrillation (PAF). However, the... (Meta-Analysis)
Meta-Analysis
Investigating the efficiency and tolerability of traditional Chinese formulas combined with antiarrhythmic agents for paroxysmal atrial fibrillation: A systematic review and Bayesian network meta-analysis.
BACKGROUND
The combination of antiarrhythmic drugs with traditional Chinese formulas are used treatments for the management of paroxysmal atrial fibrillation (PAF). However, the most effective treatment for PAF has yet to be been determined. A Bayesian network meta-analysis study was thus performed for comparing the relative efficacy and tolerability of different treatment alternatives.
METHODS
A comprehensive literature review of randomized controlled trials (RCTs) is performed from eight database. Maintenance rate of sinus rhythm (MRSR), p-wave dispersion (Pd), left atrium diameter (LAD), left ventricular ejection fraction (LVEF), and adverse events (AEs) were used as outcomes. We also estimated treatment rank based on the surface under the cumulative ranking curve (SUCRA). This study was performed using a Bayesian network meta-analysis with a random-effects model.
FINDINGS
After screening, 59 RCTs involving 5,543 patients and 16 treatments were included. The results showed that Shensong-Yangxin capsule (SSYX) plus amiodarone (81%) was the most effective treatment for MRSR according to the value of SUCRA, followed by Wenxin-Keli granules (WXKL) plus amiodarone (73%). Meanwhile, SSYX plus amiodarone (7%) was most likely to reduce Pd, followed by SSYX plus metoprolol (23%), WXKL plus amiodarone (26%), WXKL plus bisoprolol (27%). Furthermore, SSYX plus amiodarone (4%) was more effective in improving LAD. WXKL plus amiodarone was preferred because it had the lowest toxicity. For benefit-risk ratio, amiodarone combined with WXKL or SSYX appeared to be the best option.
CONCLUSION
Antiarrhythmic agents combined with traditional Chinese formulas had higher efficacy and lower toxicity than other treatment alternatives. This study might provide reference to help find the better treatment options for PAF.
Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; China; Humans; Network Meta-Analysis
PubMed: 34781230
DOI: 10.1016/j.phymed.2021.153832 -
Resuscitation Jul 2008To determine the rate of return of spontaneous circulation (ROSC) in animal models performing resuscitation from induced ventricular fibrillation (VF) in severe... (Review)
Review
OBJECTIVE
To determine the rate of return of spontaneous circulation (ROSC) in animal models performing resuscitation from induced ventricular fibrillation (VF) in severe hypothermia (<30 degrees C).
MATERIALS AND METHODS
A medical literature database search from 1966 to present was performed identifying placebo controlled trials using anti-arrhythmic or vasopressor medications to treat ventricular fibrillation in the setting of severe hypothermia.
RESULTS
7 controlled studies were identified (n=117) testing 6 combinations of resuscitative medications. ROSC rates for treatment versus control groups were as follows: amiodarone (6% vs. 18%, p=0.6, n=34), bretylium (35% vs. 35%, p=1.0, n=40), intermediate- and high-dose epinephrine (adrenaline) (36% vs. 27%, p=1.0, n=22), vasopressin (60% vs. 0%, p<0.0001, n=39), vasopressin and amiodarone (0% vs. 0%, p=NS, n=11), low-dose epinephrine and amiodarone (91% vs. 30%, p=0.0075, n=21). Cumulatively, among all studies administering vasopressors, the rate of ROSC was 62% in treatment groups contrasted to 17% in control groups (p<0.0001, n=77).
CONCLUSIONS
In controlled animal models of severe hypothermia, ROSC rates for induced ventricular fibrillation are higher with utilization of vasopressor medications. Current guidelines which recommend withholding these medications in the setting of hypothermic cardiac arrest should be re-evaluated.
Topics: Animals; Anti-Arrhythmia Agents; Disease Models, Animal; Hypothermia; Vasoconstrictor Agents; Vasopressins; Ventricular Fibrillation
PubMed: 18406039
DOI: 10.1016/j.resuscitation.2008.01.025 -
Life (Basel, Switzerland) Jul 2022Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited cardiac ion channelopathy. The present study aims to examine the clinical... (Review)
Review
INTRODUCTION
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited cardiac ion channelopathy. The present study aims to examine the clinical characteristics, genetic basis, and arrhythmic outcomes of CPVT patients from China to elucidate the difference between CPVT patients in Asia and Western countries.
METHODS
PubMed and Embase were systematically searched for case reports or series reporting on CPVT patients from China until 19 February 2022 using the keyword: "Catecholaminergic Polymorphic Ventricular Tachycardia" or "CPVT", with the location limited to: "China" or "Hong Kong" or "Macau" in Embase, with no language or publication-type restriction. Articles that did not state a definite diagnosis of CPVT and articles with duplicate cases found in larger cohorts were excluded. All the included publications in this review were critically appraised based on the Joanna Briggs Institute Critical Appraisal Checklist. Clinical characteristics, genetic findings, and the primary outcome of spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF) were analyzed.
RESULTS
A total of 58 unique cases from 15 studies (median presentation age: 8 (5.0-11.8) years old) were included. All patients, except one, presented at or before 19 years of age. There were 56 patients (96.6%) who were initially symptomatic. Premature ventricular complexes (PVCs) were present in 44 out of 51 patients (86.3%) and VT in 52 out of 58 patients (89.7%). Genetic tests were performed on 54 patients (93.1%) with a yield of 87%. RyR2, CASQ2, TERCL, and SCN10A mutations were found in 35 (71.4%), 12 (24.5%), 1 (0.02%) patient, and 1 patient (0.02%), respectively. There were 54 patients who were treated with beta-blockers, 8 received flecainide, 5 received amiodarone, 2 received verapamil and 2 received propafenone. Sympathectomy ( = 10), implantable cardioverter-defibrillator implantation ( = 8) and ablation ( = 1) were performed. On follow-up, 13 patients developed VT/VF.
CONCLUSION
This was the first systematic review of CPVT patients from China. Most patients had symptoms on initial presentation, with syncope as the presenting complaint. RyR2 mutation accounts for more than half of the CPVT cases, followed by CASQ2, TERCL and SCN10A mutations.
PubMed: 35892906
DOI: 10.3390/life12081104 -
Europace : European Pacing,... Aug 2021Single oral dose anti-arrhythmic drugs (AADs) are used to cardiovert recent-onset atrial fibrillation (AF); however, the optimal agent is uncertain. (Meta-Analysis)
Meta-Analysis
Single-dose oral anti-arrhythmic drugs for cardioversion of recent-onset atrial fibrillation: a systematic review and network meta-analysis of randomized controlled trials.
AIMS
Single oral dose anti-arrhythmic drugs (AADs) are used to cardiovert recent-onset atrial fibrillation (AF); however, the optimal agent is uncertain.
METHODS
We performed a systematic review and network meta-analysis of randomized trials testing single oral dose AADs vs. any comparator to cardiovert AF <7 days duration. We searched MEDLINE, Embase, and CENTRAL to April 2020. The primary outcome was successful cardioversion at timepoint nearest 8 h after administration.
RESULTS
From 12 712 citations, 22 trials (2320 patients) were included. Thirteen trials included patients with some degree of heart failure; 19 included patients with some degree of ischaemic heart disease vs. placebo or rate-control (32% success) at 8 h, flecainide [73%, network odds ratio (OR) 7.6, 95% credible interval (CrI) 4.4-14.0], propafenone (70%, OR 4.6, CrI 2.9-7.3), and pilsicainide (59%, OR 10.0, CrI 1.8-69.0), but not amiodarone (28%, OR 1.0, CrI 0.4-2.8) were superior. Flecainide (OR 7.5, CrI 2.6-24.0) and propafenone (OR 4.5, CrI 1.6-13.0) were superior to amiodarone; propafenone vs. flecainide did not statistically differ (OR 0.6, CrI 0.3-1.1). At longest follow-up, amiodarone was superior to placebo (OR 11.0, CrI 3.2-41.0), flecainide vs. amiodarone (OR 0.79, CrI 0.19-3.1), and propafenone vs. amiodarone (OR 0.36, CrI 0.092-1.4) were not statistically different, and flecainide was superior to propafenone (OR 2.2, CrI 1.1-4.8). Atrial and ventricular tachyarrhythmias, bradyarrhythmias, and hypotension were rare with PO AADs.
CONCLUSION
Single oral dose Class 1C AADs are effective and safe for cardioversion of recent-onset AF. Flecainide may be superior to propafenone. Amiodarone is a slower acting alternative.
Topics: Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Electric Countershock; Humans; Network Meta-Analysis; Pharmaceutical Preparations; Propafenone; Randomized Controlled Trials as Topic
PubMed: 33723602
DOI: 10.1093/europace/euab014 -
Heart Failure Reviews Mar 2018Implantable cardioverter-defibrillator (ICD) has shown to reduce sudden cardiac death and overall mortality in patients with dilated cardiomyopathy. The recently... (Meta-Analysis)
Meta-Analysis
Prophylactic use of the implantable cardioverter-defibrillator and its effect on the long-term survival, cardiovascular and sudden cardiac death in nonischemic cardiomyopathy patients-a systematic review and meta-analysis.
Implantable cardioverter-defibrillator (ICD) has shown to reduce sudden cardiac death and overall mortality in patients with dilated cardiomyopathy. The recently published DANISH trial has shown conflicting outcomes on the long-term survival in patients with prophylactic implantation of ICD in Non-Ischemic Cardiomyopathy (NICM). Two independent reviewers searched MEDLINE, PUBMED, Ovid, CINAHL, clinicaltrials.gov , and Cochrane Registry for randomized control trials (RCT's) comparing ICD to medical treatment (MT). Six RCT's enrolling 3389 patients (ICD = 1554 and MT = 1835) were included for final analysis. The primary outcomes were mortality comparing ICD to MT, 231 vs 337 (OR = 0.74, CI = 0.62-0.90, p = 0.002, and I = 0%) favoring ICD. On comparing to amiodarone only, there were 47 deaths in the ICD arm vs 71 deaths in amiodarone arm, (OR = 0.66, CI = 0.44-0.98, p = 0.04, I 0%), to placebo and usual care only (excluding amiodarone); there were 225 deaths in ICD patients compared to 266 in the placebo and usual care arm, (OR = 0.73, CI = 0.59-0.92, p = 0.007, I = 15%). The results of our analysis from these six RCTs clearly support the ongoing benefit of prophylactic ICD implantation and support current recommendations for ICD implantation in NICM patients. More RCT's at a larger scale are needed to further elucidate benefits of both ICD and CRT-D in this post PARADIGM era where MT is at a pinnacle in reducing morbidity and mortality in heart failure patients.
Topics: Cardiomyopathies; Death, Sudden, Cardiac; Defibrillators, Implantable; Global Health; Humans; Incidence; Primary Prevention; Risk Assessment; Risk Factors; Survival Rate
PubMed: 29380177
DOI: 10.1007/s10741-018-9671-6 -
Internal and Emergency Medicine Oct 2022Different cognitive aids have been recently developed to support the management of cardiac arrest, however, their effectiveness remains barely investigated. We aimed to... (Meta-Analysis)
Meta-Analysis Review
Different cognitive aids have been recently developed to support the management of cardiac arrest, however, their effectiveness remains barely investigated. We aimed to assess whether clinicians using any cognitive aids compared to no or alternative cognitive aids for in-hospital cardiac arrest (IHCA) scenarios achieve improved resuscitation performance. PubMed, EMBASE, the Cochrane Library, CINAHL and ClinicalTrials.gov were systematically searched to identify studies comparing the management of adult/paediatric IHCA simulated scenarios by health professionals using different or no cognitive aids. Our primary outcomes were adherence to guideline recommendations (overall team performance) and time to critical resuscitation actions. Random-effects model meta-analyses were performed. Of the 4.830 screened studies, 16 (14 adult, 2 paediatric) met inclusion criteria. Meta-analyses of eight eligible adult studies indicated that the use of electronic/paper-based cognitive aids, in comparison with no aid, was significantly associated with better overall resuscitation performance [standard mean difference (SMD) 1.16; 95% confidence interval (CI) 0.64; 1.69; I = 79%]. Meta-analyses of the two paediatric studies, showed non-significant improvement of critical actions for resuscitation (adherence to guideline recommended sequence of actions, time to defibrillation, rate of errors in defibrillation, time to start chest compressions), except for significant shorter time to amiodarone administration (SMD - 0.78; 95% CI - 1.39; - 0.18; I = 0). To conclude, the use of cognitive aids appears to have benefits in improving the management of simulated adult IHCA scenarios, with potential positive impact on clinical practice. Further paediatric studies are necessary to better assess the impact of cognitive aids on the management of IHCA scenarios.
Topics: Adult; Amiodarone; Cardiopulmonary Resuscitation; Child; Heart Arrest; Hospitals; Humans; Thorax
PubMed: 36031672
DOI: 10.1007/s11739-022-03041-6