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).
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