Effectiveness and Safety of Ibutilide versus Amiodarone in Cardioversion of Atrial Fibrillation and Atrial Flutter:A Meta-Analysis

Objective To evaluate the therapeutic effectiveness and safety of ibutilide versus amiodarone in the treatment of atrial fibrillation and atrial flutter.Methods An electronic search in databases including PubMed,Embase,CNKI,WanFang Data,VIP Database,and The Cochrane Library(Issue 2,2011),published from January 1994 to January 2011,was conducted to include both English and Chinese randomized controlled trials(RCTs) about ibutilide versus amiodarone in treating atrial fibrillation and atrial flutter.Two reviewers independently screened the studies according to the inclusive and exclusive criteria,extracted the data,assessed the methodological quality,and then performed Meta-analysis by using RevMan 5.0 software.Results Eight RCTs involving 506 patients were finally included.The results of Meta-analysis showed: a) The total effective rate of alleviating atrial fibrillation and atrial flutter in the ibutilide group was superior to that of the amiodarone group(OR=2.27,95%CI 1.19 to 4.33,P=0.01);b) Four RCTs showed that ibutilide was similar to amiodarone for alleviating atrial fibrillation(OR=1.61,95%CI 0.96 to 2.71,P=0.07),but the former was superior to the latter for alleviating atrial flutter(OR=8.97,95%CI 4.51 to 17.84,P0.000?01);c) Five RCTs showed that ibulitide took shorter time to alleviate atrial fibrillation and atrial flutter compared with amiodarone(WMD= –126.55 min,95%CI –202.35 to –50.76,P=0.001);d) Four RCTs showed that the total adverse effect rates in the two groups had no significant difference(OR=1.13,95%CI 0.37 to 3.43,P=0.83),but there were more cardiovascular side-effects in the ibutilide group(OR=2.36,95%CI 1.40 to 4.01,P=0.001).Conclusion Compared with amiodarone,ibutilide has a higher total effective rate in cardioversion of atrial fibrillation and atrial flutter,and it obviously takes shorter time to alleviate atrial fibrillation and atrial flutter,but there is no significant difference in the cardioversion rate of atrial fibrillation between them.There is no significant difference in total side-effect rates between the two groups,but the cardiovascular adverse reaction in the ibutilide group is significantly higher than that of the amiodarone group.Because of the limited quantity and quality of the included studies,this conclusion has to be further proved by more high-quality RCTs.