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• W2892443706 abstract "Stable sustained monomorphic ventricular tachycardia (VT) may be terminated with intravenous (IV) antiarrhythmic drugs (AADs). Several AADs have demonstrated to be efficacious within a few randomized controlled trials. The purpose of this study is to perform a systematic review of randomized controlled trials comparing the efficacy of antiarrhythmic drugs in terminating VT, and to perform a network meta-analysis to compare efficacy across AADs. We conducted a large systematic search of published trials, using the electronic databases MEDLINE, Embase and Cochrane Central Register of Controlled Trials in the Cochrane Library. Two investigators independently screened titles and abstracts from each database. High quality systematic reviews on the same research question were also reviewed. To conduct this systematic review and network meta-analysis we use the standard PICOS approach: inclusion criteria were adults ≥ 18 years presenting with hemodynamically stable monomorphic VT, with or without structural heart disease. Intervention was the use of IV AADs to terminate VT. Comparison was head-to-head of AAD against one another; agents included: Amiodarone, Sotalol, Dofetelide, Mexiletine, Lidocaine, Procainamide, Ajmaline. The primary outcome was successful conversion of VT within the same medical encounter. Secondary outcome was time to conversion. Study Design must be RCT. Assessment of risk of bias and quality of evidence was performed. A NMA was conducted to directly and indirectly compare the efficacy of competitive AADs. Estimates of treatment effect were calculated with a Bayesian framework using WinBUGs software. Results were presented as relative risks (RRs) and 95% credible intervals (CrIs). A total of 518 abstracts were screened and three randomized studies enrolling 124 patients were included. Four AADs were analyzed including, Lido/lignocaine, Sotalol, Procainamide and Amiodarone. Regarding the relative treatment effect (Random-effect), Procainamide IV and Sotalol IV and were significantly more effective than Lido/lignocaine IV for VT conversion, [3.90 (1.48 - 10.46) and 4.31 (1.77-11.15); RR with 95% CrI respectively]. Both Procainamide IV and Amiodarone IV were not superior to Sotalol for VT conversion [1.10 (0.49 - 2.72) and 0.76 (0.14 - 2.26) respectively]. Amiodarone was seemingly more effective than Lido/lignocaine, [2.90 (0.53- 8.93), but not statistically significant. Amiodarone IV seemingly was less effective than Procainamide [0.69 (0.21 - 1.02)]. More patients in the Amiodarone group required electrical cardioversion, due to hypotension [20.7 % (6/29)]. Based on available data from the RCT and the Network Meta-analysis of AAD to terminate VT, Procainamide appeared to be the best AAD to terminate VT." @default.
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• W2892443706 date "2018-10-01" @default.
• W2892443706 modified "2023-10-16" @default.
• W2892443706 title "NETWORK META-ANALYSIS ON THE EFFICACY OF ANTIARRHYTHMIC DRUGS FOR THE TERMINATION OF VENTRICULAR TACHYCARDIA" @default.
• W2892443706 doi "https://doi.org/10.1016/j.cjca.2018.07.344" @default.
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