Amiodarone may be more effective than flecainide in patients with atrial fibrillation who are refractory to type IA antiarrhythmic agents. The impact of amiodarone on mortality remains to be determined.
A systematic review 1 including 6 studies of amiodarone with 315 patients and 2 studies of flecainide with 163 patients was abstracted in DARE. After 3 months the proportion of amiodarone-treated patients remaining in sinus rhythm was significantly greater than that expected with the quinidine standard (72.6% compared with 70%, pooled difference 3.5%). After 6 months, the corresponding figure were 71% and 58%, pooled rate difference 13.8%. After 12 months the figures were 60% and 50%, pooled rate difference 10.4%. There was a 29% incidence of adverse effects with amiodarone. For flecainide after 3 months, 48.5% of patients remained in sinus rhythm compared to 70% of the quinidine standard. After 12 months the corresponding figures were 34% and 50%.
Comment: The quality of evidence is downgraded by sparse data and indirectness (there was no direct comparison of amiodarone and flecainide).
1. Zarembski DG, Nolan PE Jr, Slack MK, Caruso AC. Treatment of resistant atrial fibrillation. A meta-analysis comparing amiodarone and flecainide. Arch Intern Med 1995 Sep 25;155(17):1885-91. [PMID:7677555]
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"Amiodarone and Flecainide in the Treatment of Resistant Atrial Fibrillation." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/452784/all/Amiodarone_and_flecainide_in_the_treatment_of_resistant_atrial_fibrillation.
Amiodarone and flecainide in the treatment of resistant atrial fibrillation. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/452784/all/Amiodarone_and_flecainide_in_the_treatment_of_resistant_atrial_fibrillation. Accessed February 20, 2020.
Amiodarone and flecainide in the treatment of resistant atrial fibrillation. (2019). In Evidence-Based Medicine Guidelines. Available from https://evidence.unboundmedicine.com/evidence/view/EBMG/452784/all/Amiodarone_and_flecainide_in_the_treatment_of_resistant_atrial_fibrillation
Amiodarone and Flecainide in the Treatment of Resistant Atrial Fibrillation [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2020 February 20]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/452784/all/Amiodarone_and_flecainide_in_the_treatment_of_resistant_atrial_fibrillation.
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