PubMed1999
Many clinicians choose sotalol for the prevention of recurrences of atrial fibrillation (AF) as an alternative to quinidine, which has been associated with an increase in long-term mortality. Using meta-analytic techniques, we compared the effects on maintenance of sinus rhythm and mortality of combined groups of patients with chronic AF treated with sotalol, quinidine, or a control drug. Rates of conversion at 6 months and mortality were combined for each group after performing sensitivity analysis to test for homogeneity. Bayesian estimates and corresponding 95% credibility intervals were constructed to compare the probabilities of achieving sinus rhythm and mortality among groups. A literature search revealed 4 sotalol studies, 6 quinidine studies, and 5 control studies that met inclusion criteria established a priori. The point estimates for maintaining normal sinus rhythm (at 6 months) and corresponding credibility intervals for the 3 groups were sotalol 50% (range 42% to 58%), quinidine 53% (range 48% to 59%), and control 32% (range 26% to 39%). When combining and comparing mortality effects, the following studies met the same inclusion criteria: 4 sotalol studies, 9 quinidine studies, and 7 control studies. The point estimates and corresponding credibility intervals for mortality in the 3 groups were sotalol 2.2% (range 0.6% to 4.8%), quinidine 3.0% (range 1.7% to 4.7%), and control 1.1% (range 0.3% to 2.4%). Sotalol and quinidine are comparable in their ability to maintain sinus rhythm at 6 months (about 50%) and both agents are superior to control. There is a trend for both agents to increase mortality with long-term therapy. These data do not support choosing sotalol over quinidine as a safer alternative for preventing recurrences of chronic AF.