Objective To assess the effectiveness and safety of ibutilide and propafenone in the treatment of atrial fibrillation (AF) and atrial flutter (AFL). Methods All randomized controlled trials (RCTs) on ibutilide and propafenone for AF and AFL were retrieved from databases including CBM (1978 to October 2011), VIP (1989 to October 2011), CNKI (1994 to October 2011) and WanFang Data (1998 to October 2011). The quality of included RCTs was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions Version 4.2.6, and the Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results 16 RCTs involving 1 196 patients were included. Results of meta-analysis showed that: a) About effectiveness: compare with propafenone applied as routine therapy, ibutilide was more effective in the total conversion rate of AF and AFL with regards to the time of 0~90 min, 0~4 hour and 0~24 hour with significant differences (OR=3.32, OR=2.69, OR=3.08, respectively, Plt;0.000 1); In subgroup analysis, a significant difference was found in the conversion rate of AF or AFL in the time of 0~90min. In the time duration for conversion, there was a significant difference (MD=–25.12, 95%CI –30.43 to –19.82, Plt;0.000 01); and b) About the safety: there was a significant difference between the two groups in the incidence of cardiac arrhythmia (OR=3.15, 95%CI 1.97 to 5.05, Plt;0.000 01) and other adverse effects (OR=0.16, 95%CI 0.08 to 0.33, Plt;0.000 01). Conclusion Current evidence shows that ibutilide is more effective than propafenone in converting AF or AFL, with a higher incidence of cardiac arrhythmia than propafenone. However, more high-quality, large-scale RCTs are still needed to confirm the effectiveness and safety of ibutilide and propafenone for AF/AFL because of the limitation of the methodological quality and sample size of the included studies.
Objective To evaluate the efficacy and safety of Shen Song Yang Xin Capsule for cardiac arrhythmia. Methods Randomized controlled trials (RCTs) were searched from the following electronic databases: WanFang, CNKI, CBM, VIP, PubMed, and The Cochrane Library. Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. All data were analyzed by using RevMan 5.0 software. Results Thirteen studies involving 1896 participants were included. The results of meta-analyses showed that compared with the control group, a) efficacy: Shen Song Yang Xin Capsule was superior to mexiletine (OR=2.96, 95%CI 1.79 to 4.87), and propafenone (OR=2.41, 95%CI 1.60 to 3.62), but was not superior to miodarone (OR=1.25, 95%CI 0.88 to 1.71); b) safety: Shen Song Yang Xin Capsule was superior to propafenone and miodarone in reducing the incidence of cardiac arrhythmia (OR=0.06, 95%CI 0.01 to 0.35; OR=0.05, 95%CI 0.02 to 0.17), but no significant difference was found between the two groups in incidence of gastrointestinal adverse reactions. Conclusion Based on the current studies, Shen Song Yang Xin Capsule is not inferior to the commonly-used anti-arrhythmic medicine at present. It has lower incidence of cardiac arrhythmia, and has no significant difference in the incidence of gastrointestinal adverse reactions compared with western drugs. For the quality restrictions of the included studies, more double blind RCTs with high quality are required to further assess the effects.