Meta-Analysis Of Efficacy Of Ibutilide In Converting Atrial Fibrillation To Sinus Rhythm

Background:Multiple randomized controlled trials (RCTs) that have examined the effects of ibutilide have provided unexplained conflicting results. A meta-analysis of these RCTs may be helpful to assess the effects of intravenous ibutilide on converting atrial fibrillation to sinus rhythm in patients with atrial fibrillation.Methods:The Cochrane library, Pubmed, EMBASE and MEDLINE were systematically searched to identify all interventional trials of ibutilide with placebo or all other antiarrhythmic drugs in converting atrial fibrillation to sinus rhythm. The primary outcome was rate of converting to sinus rhythm. Meta-analyses were carried out using Mantel-Haenszel random-effects models and heterogeneity was assessed by the X2test with RevMan5.0; and the publication bias was assessed with funnel plot.Results:A total of12RCTs (n=1822) met our inclusion criteria. The result of heterogeneity was I2=88%, indicating there was heterogeneity among the including studies. Ibutilide was superior in achieving sinus rhythm for atrial fibrillation (AF) comparing to placebo or alternative anti-arrhythmic agents (relative risk [RR]=2.01,95%Confidence Interval [CI]=1.35to2.99). In subgroup containing only studies with AF alone, ibutilide also showed significant efficacy in achieving sinus rhythm (SR)(RR=1.58,95%CI=1.10to2.28; P=0.01). However, there is no significant efficacy of ibutilde for post-operative AF (RR=1.69,95%CI=0.93to3.08; P=0.09).Conclusion:Intravenous ibutilide was superior in converting AF to SR comparing with other antiarrhythmic agents. However, the efficacy of ibutilide is not significant in post-operative AF. Although use of ibutilide is apparently safe, safety data are too scarce for definitive conclusions.