atrial fibrillation

systematic review meta-analysis network meta-analysis

Select catheter ablation embolic protectionantithromboticsdirect antithrombinsdirect factor Xa inhibitorsdirect oral anticoagulant (DAO)antiarrythmic drugsanticoagulant after PCIpreventionrate controlrythm control All type of patientmaintaining sinus rhythm after cardioversionprimary preventionprimary prevention of thromboembolic eventsrate controluncoded clinical condition ***       amiodarone/dronedaroneangiotensin receptor blockeranticoagulantanticoagulants + antiplatelet agentscatheter ablationCEIClass IaClass IcClass II: Beta-blockersClass IIIgemfibrozilinhibition of renin-angiotensin systemLLA closureomega-3 polyunsaturated fatty acidsoral direct thrombin inhibitororal factor Xa inhibitorsOthers class Iplatelet aggregation inhibitorsrate controlRhythm controlstatinssynthetic oligosaccharide atorvastatinpravastatinrosuvastatinenalaprillisinoprilramiprilirbesartanlosartanvalsartancandesartanamiodaroneapixabanaspirinAzimilidecatheter ablationclopidogrelcoumadindabigatrandisopyramidedofetilidedronedaroneedoxabanflecainidegemfibrozilidraparinuxmetoprolololmesartanpropafenonequinidinerivaroxabansotaloltriflusalwarfarinximelagatran vs beta-blockersvs placebovs placebo or controlvs amiodaronevs anticoagulantvs antiplatelet drugsvs Class Ivs Class Iavs Class Icvs Class IIvs Class IIIvs controlvs digoxinvs rate controlvs rythm control      

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Group by Group by... nothing pathology treatment patient comparator classe classe comparator mechanism clinical condition MA  in first nothing pathology treatment patient comparator classe classe comparator mechanism clinical condition  in second nothing pathology treatment patient comparator classe classe comparator mechanism clinical condition  in third	Description Synopsis Comparison Treatments Patients Characteristics Method Risk of bias References None Tools Indexation					Results Global trial result Main results All results All result tag NCT results	All cause death (146)Major bleeding (69)Atrial fibrillation recurrence (69)Pro-arrhythmia (61)thrombo-embolic event (cerebral or systemic) (59)Adverse events leading to treatment discontinuation (59)stroke (fatal and non fatal) (58)Haemmorhagic stroke (54)ischemic stroke (53)Cardiovascular death (47)Fatal stroke (47)systemic thrombo-embolic complication (46)TE event or ischemic stroke or systemic embolism (41)Fatal bleeding (27)Coronary event (21)Gastrointestinal major bleeding (21)Lifethreatening major bleeding (15)major or clinically relevant non-major bleeding (15)stroke or TIA (14)Non fatal stroke (13)combined endpoint (12)atrial fibrillation (11)atrial fibrillation recurrence (9)Peripheral embolism (8)Hospitalization for any reason (8)Freedom from arrhythmia at 12 months per protocol (7)freedom from arrhythmia at 12 months - worst case (7)Freedom from arrhythmia at 12 months - ITT (7)Atrial fibrillation follow-up (6)Non-lifethreatening major bleeding (6)death or hospitalization for cardiac causes (6)atrial tachyarrhythmia recurrence free survival (6)Vascular death (6)Minor bleeding (6)Non vascular death (5)Adverse events (4)hospitalisation for heart failure (4)hypertransaminasemia (3)cardiovascular events (3)Cardiac arrhythmic death (3)intracranial hemorrhage (3)myocardial infarction (fatal and non fatal) (3)death by cardiac arrhythmia (2)non cardiovascular death (1)Cardiac nonarrhythmic death (1)Vascular noncardiac death (1)hospitalization for AF (1)Any Atrial Arrhythmia Recurrence (1)death, stroke,stroke, serious bleeding, cardiac arrest (1)more than one AF recurrence (1)Vascular events (1)Deep vein thrombosis (1)device retrieval, pericardial effusion, major bleeding (1)stroke, cardiovascular or unexplained death, systemic embolization (1)Symptomatic Atrial Arrhythmia recurrence (1) Options Numeric bar chart forest plot medians
Trial	Studied trt	Control trt	patients	tags	ROB	Trial result	All cause death	Major bleeding
antiarrythmic drugs
not classified
SMART, 2002	aprindine	placebo			Low risk of bias	negative
AFIB, 1997	bidisomide	placebo				negative
P-OM3 (Kowey), 2010	n-3 PUFA	placebo			Low risk of bias	negative
Okishige, 2000	pilsicainide	placebo				suggesting
RACE II, 2010    NCT	lenient rate control	strict rate control			Risk of bias	negative
amiodarone
Channer, 2004	amiodarone	placebo			Low risk of bias	suggesting
GEFACA, 2001	amiodarone	placebo			Low risk of bias	suggesting
Kochiadakis (amiodarone vs placebo), 2000	amiodarone	placebo				suggesting
SAFE-T (amiodarone vs placebo), 2005	amiodarone	placebo			Low risk of bias	suggesting
AFFIRM Substudy (amiodarone vs class I drugs), 2003	amiodarone	class I drugs			Risk of bias	suggesting
AFFIRM Substudy (sotalol vs class I drugs), 2003	amiodarone	class I drugs				-
Villani, 1992	amiodarone	disopyramide				suggesting
Kochiadakis a, 2004	amiodarone	propafenone				negative
Vitolo, 1981	amiodarone	quinidine				suggesting
AFFIRM Substudy (amiodarone vs sotalol), 2003	amiodarone	sotalol				suggesting
Kochiadakis (amiodarone vs sotalol), 2000	amiodarone	sotalol				-
SAFE-T (amiodarone vs sotalol), 2005	amiodarone	sotalol			Low risk of bias	-
Azimilide
ASAP, 2003	Azimilide	placebo			Low risk of bias	negative
disopyramide
Karlson, 1998	disopyramide	placebo				negative
Lloyd (Disopyramide vs placebo), 1984	disopyramide	placebo			Low risk of bias	negative
PRODIS, 1996	disopyramide	propafenone			Low risk of bias	negative
Lloyd (Disopyramide vs quinidine), 1984	disopyramide	quinidine			Low risk of bias	-
dofetilide
DIAMOND, 2001	dofetilide	placebo			Low risk of bias	suggesting
SAFIRE-D, 2000	dofetilide	placebo			Low risk of bias	suggesting
dronedarone
EURIDIS, 2007      NCT	dronedarone	placebo			Low risk of bias	suggesting
ADONIS, 2007    NCT	dronedarone	placebo			Low risk of bias	suggesting
DAFNE, 2003	dronedarone	placebo			Low risk of bias	suggesting
EURIDIS ADONIS (pooled analysis), 2009	dronedarone	placebo			Low risk of bias	negative
ATHENA, 2009      NCT	dronedarone	placebo			Low risk of bias	suggesting
PALLAS, 2011        NCT	dronedarone	placebo			Low risk of bias	negative
ERATO, 2008	dronedarone	placebo			Low risk of bias	negative
DIONISOS, 2007      NCT	dronedarone	amiodarone			Low risk of bias	suggesting
flecainide
Van Gelder, 1989	flecainide	no treatment				negative
Carunchio (flecainide vs placebo), 1995	flecainide	placebo				suggesting
Steinbeck (flecainide vs digoxin), 1988	flecainide	digoxin				suggesting
Aliot, 1996	flecainide	propafenone				suggesting
Naccarelli, 1996	flecainide	quinidine			Low risk of bias	negative
metoprolol
Kuhlkamp, 2000	metoprolol	placebo				negative
propafenone
Bellandi (propafenone vs placebo), 2001	propafenone	placebo			Low risk of bias	suggesting
Dogan, 2004	propafenone	placebo				suggesting
Kochiadakis b (propafenone vs placebo), 2004	propafenone	placebo				suggesting
RAFT, 2003	propafenone	placebo			Low risk of bias	suggesting
Stroobandt, 1997	propafenone	placebo			Low risk of bias	negative
FAPIS, 1996	propafenone	flecainide				negative
Richiardi, 1992	propafenone	quinidine				negative
Reimold, 1993	propafenone	sotalol				negative
quinidine
Hillestad, 1971	quinidine	no treatment				negative
Sodermark, 1975	quinidine	no treatment				suggesting
Lloyd (quinidine vs placebo), 1984	quinidine	placebo			Low risk of bias	negative
PAFAC (quinidine vs placebo), 2004	quinidine	placebo			Low risk of bias	suggesting
SOPAT (quinidine vs placebo), 2004	quinidine	placebo			Low risk of bias	suggesting
Byrne Quinn, 1979	quinidine	placebo			Low risk of bias	suggesting
Steinbeck (quinidine vs digoxin), 1988	quinidine	digoxin				negative
Lloyd (quinidine vs disopyramide), 1984	quinidine	disopyramide			Low risk of bias	-
Steinbeck (quinidine vs flecainide), 1988	quinidine	flecainide				-
Hohnloser, 1995	quinidine	sotalol				negative
Juul-Moller, 1990	quinidine	sotalol				negative
Kalusche, 1994	quinidine	sotalol				negative
SOCESP, 1999	quinidine	sotalol				negative
PAFAC (quinidine vs sotalol), 2004	quinidine	sotalol			Low risk of bias	-
SOPAT (quinidine vs sotalol), 2004	quinidine	sotalol			Low risk of bias	-
sotalol
Benditt, 1999	sotalol	placebo			Low risk of bias	negative
Singh, 1991	sotalol	placebo			Low risk of bias	suggesting
Bellandi (sotalol vs placebo), 2001	sotalol	placebo			Low risk of bias	suggesting
Carunchio (sotalol vs placebo), 1995	sotalol	placebo				suggesting
Kochiadakis (sotalol vs placebo), 2000	sotalol	placebo				-
Kochiadakis b (sotalol vs placebo), 2004	sotalol	placebo				suggesting
PAFAC (sotalol vs placebo), 2004	sotalol	placebo			Low risk of bias	suggesting
SAFE-T (sotalol vs placebo), 2005	sotalol	placebo			Low risk of bias	suggesting
SOPAT (sotalol vs placebo), 2004	sotalol	placebo			Low risk of bias	negative
Plewan, 2001	sotalol	bisoprolol				negative
Carunchio (sotalol vs flecianide), 1995	sotalol	flecainide				-
Kochiadakis b (sotalol vs propafenome), 2004	sotalol	propafenone				-
antithrombotics
not classified
Japanese AF Trial, 2006	aspirin	control				-
EAFT, 1993	oral anticoagulant	placebo				suggesting
ENGAGE-AF TIMI 48 Low dose, 2013    NCT	edoxaban low dose	warfarin standard dose			Low risk of bias	suggesting
phase 2 AZD0837    NCT	AZD0837	aspirin			Exploratory	-
NASPEAF (triflusal + coumadin medium dose vs coumadin standard dose), 2004	triflusal+coumadin medium dose	coumadin standard dose			Risk of bias	suggesting
NASPEAF (triflusal+coumadin medium dose vs triflusal), 2004	triflusal+coumadin medium dose	triflusal			Low risk of bias	suggesting
SIFA, 1997      NCT	Indobufen	warfarin				suggesting
Lip (phase 2 AZD0837), 2009    NCT	AZD0837	warfarin standard dose			Exploratory	-
phase 2 YM150    NCT	YM150	warfarin standard dose			Exploratory	-
apixaban
AVERROES, 2011        NCT	apixaban	aspirin	ineligible for VKA		Low risk of bias	suggesting
ARISTOTLE, 2011        NCT	apixaban	warfarin standard dose			Low risk of bias	conclusive
phase 2 apixaban    NCT	apixaban	warfarin standard dose			Exploratory	-
aspirin
LASAF(aspirin vs no treatment), 1999	aspirin	control				-
AFASAK (aspirin vs placebo), 1989	aspirin	placebo			Low risk of bias	negative
SPAF (aspirin,warfarin ineligible arm), 1991	aspirin	placebo	ineligible for VKA		Low risk of bias	negative
SPAF (aspirin , warfarin eligible arm), 1991	aspirin	placebo			Low risk of bias	suggesting
EAFT, 1993	aspirin	placebo			Low risk of bias	negative
FFAACS , 2001	aspirin	placebo (on top fluidione)			Low risk of bias	negative
PATAF (vs coumadin low dose), 1999	aspirin	coumadin low dose			Risk of bias	negative
PATAF (vs coumadin standard dose), 1999	aspirin	coumadin standard dose			Risk of bias	negative
AFASAK II (aspirin vs warfarin low dose), 1998	aspirin	warfarin low dose			Risk of bias	negative
SPAF II (aspirin vs warfarin standard dose, age<75), 1994	aspirin	warfarin standard dose			Risk of bias	negative
AFASAK II (aspirin vs warfarin standard dose), 1998	aspirin	warfarin standard dose			Risk of bias	negative
SPAF II (aspirin vs warfarin standard dose, age>75), 1994	aspirin	warfarin standard dose			Risk of bias	negative
AFASAK (aspirin vs warfarin standard dose), 1989	aspirin	warfarin standard dose			Risk of bias	negative
clopidogrel
ACTIVE W, 2006    NCT	aspirin + clopidogrel	anticoagulant			Risk of bias	suggesting
ACTIVE A, 2009      NCT	aspirin + clopidogrel	aspirin			Low risk of bias	suggesting
coumadin
PATAF (coumadin low dose vs coumadin standard dose), 1999	coumadin low dose	coumadin standard dose			Risk of bias	negative
dabigatran
RE-LY 110mg (2nd prevention subgroup) , 2010	dabigatran 100mg	warfarin			Exploratory	suggesting
RE-LY 150mg (2nd prevention subgroup)	dabigatran 150mg	warfarin			Exploratory	suggesting
phase 2 dabigatran    NCT	dabigatran	warfarin standard dose			Exploratory	-
RE-LY (110mg), 2009      NCT	dabigatran 110mg	warfarin standard dose			Risk of bias	suggesting
PETRO (150mg), 2007	dabigatran 150mg	warfarin standard dose			Exploratory	-
RE-LY (150mg), 2009      NCT	dabigatran 150mg	warfarin standard dose			Risk of bias	suggesting
edoxaban
Weitz (edoxaban phase 2)    NCT	edoxaban	warfarin standard dose			Exploratory	-
phase 2 edoxaban    NCT	edoxaban	warfarin standard dose			Exploratory	-
ENGAGE-AF TIMI 48 High dose, 2013    NCT	edoxaban high dose	warfarin standard dose			Low risk of bias	suggesting
idraparinux
AMADEUS, 2008      NCT	idraparinux	warfarin standard dose			Risk of bias	negative
rivaroxaban
ROCKET (2nd prevention subgroup) , 2011	rivaroxaban	warfarin			Low risk of bias	negative
ROCKET-AF, 2010        NCT	rivaroxaban	warfarin standard dose			Low risk of bias	suggesting
triflusal
NASPEAF (triflusal vs coumadin standard dose)), 2004	triflusal	coumadin standard dose			Risk of bias	negative
warfarin
BAATAF (warfarin vs no treatment), 1990    NCT	warfarin low dose	control			Risk of bias	suggesting
SAFT(warfarin low dose + aspirin vs no treatment), 2003	warfarin low dose + aspirin	control			Risk of bias	negative
AFASAK (warfarin standard dose vs control), 1989	warfarin standard dose	control			Risk of bias	suggesting
SPAF (warfarin standard dose), 1991	warfarin standard dose	control			Risk of bias	suggesting
SPINAF (warfarin vs placebo), 1992	warfarin low dose	placebo			Low risk of bias	negative
CAFA, 1991	warfarin standard dose	placebo			Low risk of bias	negative
AFASAK II (warfarin low dose+aspirin vs warfarin standard dose), 1998	warfarin + aspirin	warfarin standard dose			Risk of bias	negative
SPAF III, 1996	warfarin + aspirin	warfarin standard dose			Risk of bias	remark
AFASAK II (warfarin low dose vs warfarin standard dose), 1998	warfarin low dose	warfarin standard dose			Risk of bias	negative
MWNAF, 1998	warfarin low dose	warfarin standard dose			Risk of bias	negative
ximelagatran
SPORTIF II (ximelagatran vs warfarin standard dose), 2002	ximelagatran	warfarin standard dose			Risk of bias	-
SPORTIF III, 2003	ximelagatran	warfarin standard dose			Risk of bias	suggesting
SPORTIF V, 2005	ximelagatran	warfarin standard dose			Low risk of bias	suggesting
catheter ablation
catheter ablation
A4 (Jais), 2008      NCT	catheter ablation	control			Risk of bias	suggesting
Wazni , 2005	catheter ablation	control			Risk of bias	suggesting
APAF (Pappone), 2006	catheter ablation	control			Risk of bias	suggesting
CAFCOAF (Stabile), 2006	catheter ablation	control			Risk of bias	suggesting
Krittayaphong, 2003	catheter ablation	control			Risk of bias	suggesting
ThermoCool AF, 2008      NCT	catheter ablation	control			Risk of bias	suggesting
Oral, 2006	catheter ablation	control			Low risk of bias	suggesting
Forleo, 2009	catheter ablation	control			Risk of bias	suggesting
Lakkireddy, 2006	catheter ablation	control			Risk of bias	-
CABANA, 2018    NCT	catheter ablation	control			Risk of bias	suggesting
STOP-AF, 2010      NCT	catheter ablation	control			Risk of bias	-
direct antithrombins
dabigatran
RE-LY (110mg), 2009      NCT	dabigatran 110mg	warfarin standard dose			Risk of bias	suggesting
PETRO (150mg), 2007	dabigatran 150mg	warfarin standard dose			Exploratory	-
RE-LY (150mg), 2009      NCT	dabigatran 150mg	warfarin standard dose			Risk of bias	suggesting
ximelagatran
SPORTIF II (ximelagatran vs warfarin standard dose), 2002	ximelagatran	warfarin standard dose			Risk of bias	-
SPORTIF III, 2003	ximelagatran	warfarin standard dose			Risk of bias	suggesting
SPORTIF V, 2005	ximelagatran	warfarin standard dose			Low risk of bias	suggesting
direct factor Xa inhibitors
not classified
ENGAGE-AF TIMI 48 Low dose, 2013    NCT	edoxaban low dose	warfarin standard dose			Low risk of bias	suggesting
phase 2 YM150    NCT	YM150	warfarin standard dose			Exploratory	-
apixaban
AVERROES, 2011        NCT	apixaban	aspirin	ineligible for VKA		Low risk of bias	suggesting
ARISTOTLE, 2011        NCT	apixaban	warfarin standard dose			Low risk of bias	conclusive
phase 2 apixaban    NCT	apixaban	warfarin standard dose			Exploratory	-
edoxaban
Weitz (edoxaban phase 2)    NCT	edoxaban	warfarin standard dose			Exploratory	-
phase 2 edoxaban    NCT	edoxaban	warfarin standard dose			Exploratory	-
ENGAGE-AF TIMI 48 High dose, 2013    NCT	edoxaban high dose	warfarin standard dose			Low risk of bias	suggesting
rivaroxaban
ROCKET-AF, 2010        NCT	rivaroxaban	warfarin standard dose			Low risk of bias	suggesting
direct oral anticoagulant (DAO)
not classified
ENGAGE-AF TIMI 48 Low dose, 2013    NCT	edoxaban low dose	warfarin standard dose			Low risk of bias	suggesting
phase 2 AZD0837    NCT	AZD0837	aspirin			Exploratory	-
Lip (phase 2 AZD0837), 2009    NCT	AZD0837	warfarin standard dose			Exploratory	-
phase 2 YM150    NCT	YM150	warfarin standard dose			Exploratory	-
apixaban
ARISTOTLE, 2011        NCT	apixaban	warfarin standard dose			Low risk of bias	conclusive
phase 2 apixaban    NCT	apixaban	warfarin standard dose			Exploratory	-
dabigatran
phase 2 dabigatran    NCT	dabigatran	warfarin standard dose			Exploratory	-
RE-LY (110mg), 2009      NCT	dabigatran 110mg	warfarin standard dose			Risk of bias	suggesting
PETRO (150mg), 2007	dabigatran 150mg	warfarin standard dose			Exploratory	-
RE-LY (150mg), 2009      NCT	dabigatran 150mg	warfarin standard dose			Risk of bias	suggesting
edoxaban
Weitz (edoxaban phase 2)    NCT	edoxaban	warfarin standard dose			Exploratory	-
phase 2 edoxaban    NCT	edoxaban	warfarin standard dose			Exploratory	-
ENGAGE-AF TIMI 48 High dose, 2013    NCT	edoxaban high dose	warfarin standard dose			Low risk of bias	suggesting
idraparinux
AMADEUS, 2008      NCT	idraparinux	warfarin standard dose			Risk of bias	negative
rivaroxaban
ROCKET-AF, 2010        NCT	rivaroxaban	warfarin standard dose			Low risk of bias	suggesting
ximelagatran
SPORTIF II (ximelagatran vs warfarin standard dose), 2002	ximelagatran	warfarin standard dose			Risk of bias	-
SPORTIF III, 2003	ximelagatran	warfarin standard dose			Risk of bias	suggesting
SPORTIF V, 2005	ximelagatran	warfarin standard dose			Low risk of bias	suggesting
embolic protection
not classified
PROTECT-AF    NCT	Watchman	warfarin				negative
prevention
not classified
TRACE (AF ancillary study), 1999	trandolapril	placebo				suggesting
atorvastatin
Ozaydin, 2006	atorvastatin	control			Exploratory	suggesting
Almroth, 2009	atorvastatin	placebo			Low risk of bias	suggesting
MIRACL (sub-group) (Schwartz), 2004	atorvastatin	placebo			Low risk of bias	suggesting
Dernellis, 2006	atorvastatin	placebo			Exploratory	suggesting
ARMYDA-3 (AF ancillary study), 2006	atorvastatin	placebo				suggesting
Chello, 2006	atorvastatin	placebo			Low risk of bias	negative
MIRACL (AF ancillary study), 2001	atorvastatin	placebo			Low risk of bias	negative
candesartan
CAPRAF (Tveit), 2007      NCT	candesartan	placebo			Low risk of bias	-
CHARM (AF ancillary study), 2005	candesartan	placebo				suggesting
enalapril
Ueng, 2003	enalapril	control				suggesting
SOLVD (AF ancillary study), 2003	enalapril	placebo				suggesting
gemfibrozil
VA HIT (AF ancillary study), 1999	gemfibrozil	placebo			Low risk of bias	negative
irbesartan
Madrid, 2002	irbesartan	control				suggesting
ACTIVE I, 2009    NCT	irbesartan	placebo			Low risk of bias	suggesting
lisinopril
Van den Burg, 1995	lisinopril	placebo			Low risk of bias	negative
GISSI-3 (AF ancillary study), 2003	lisinopril	placebo				negative
losartan
LIFE (AF ancillary study), 2005	losartan	atenolol				suggesting
pravastatin
Tveit, 2004	pravastatin	control			Exploratory	negative
rosuvastatin
GISSI HF (subgroup and ancillary study), 2009    NCT	rosuvastatin	placebo			Low risk of bias	negative
valsartan
GISSI-AF (Disertori), 2009      NCT	valsartan	placebo			Low risk of bias	negative
Val-HeFT (AF ancillary study), 2003	valsartan	placebo				suggesting
rate control
not classified
Hot cafe (rate vs rythm control), 2004	rate control	electrical cardioversion				negative
RACE (rate vs rythm control), 2002	rate control	electrical cardioversion				negative
STAF (rate vs rythm control), 2003	rate control	electrical cardioversion				negative
AFFIRM (rate vs rythm control), 2002      NCT	rate control	pharmacological cardioversion				suggesting
PIAF (rate vs rythm control), 2000	rate control	pharmacological cardioversion				suggesting
AF-CHF (rate vs rythm control), 2002    NCT	rate control	pharmacological cardioversion				-
RACE II, 2010    NCT	lenient rate control	strict rate control			Risk of bias	negative
rythm control
not classified
P-OM3 (Kowey), 2010	n-3 PUFA	placebo			Low risk of bias	negative
Hot cafe, 2004	electrical cardioversion	rate control			Risk of bias	suggesting
RACE, 2002	electrical cardioversion	rate control			Risk of bias	suggesting
STAF, 2003	electrical cardioversion	rate control			Risk of bias	suggesting
AFFIRM, 2002      NCT	pharmacological cardioversion	rate control			Risk of bias	negative
PIAF, 2000	pharmacological cardioversion	rate control			Risk of bias	negative
AF-CHF, 2002    NCT	pharmacological cardioversion	rate control			Risk of bias	-