Role of antazoline in cardioversion of atrial fibrillation: A PRISMA-compliant systematic review and meta-analysis.
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Antazoline, a first-generation antihistamine with antiarrhythmic properties, has shown efficacy in the rapid conversion of recent-onset AF to sinus rhythm; however, direct comparative evidence against standard antiarrhythmic agents remains limited. This study aims to systematically evaluate the efficacy and safety of antazoline for pharmacological cardioversion of AF, in comparison with standard antiarrhythmic agents such as amiodarone and propafenone.
The methodology of this systematic review and meta-analysis adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search was conducted in ScienceDirect, Embase, PubMed, and Cochrane Library from inception to April 2025, including citation and reference screening. Statistical analyses were performed using R version 2025.05.0 + 496.
From 172 records, 5 studies comparing antazoline with propafenone (n = 5) or amiodarone (n = 3) for AF were included. For antazoline vs propafenone, conversion to sinus rhythm favored antazoline (risk ratio [RR] 1.13 [95% confidence interval (CI): 1.04-1.23], P = .017). No significant difference was observed in time to conversion (mean difference -10.98 [95% CI: -124.93-102.98], P = .436), bradycardia (RR 0.84 [95% CI: 0.35-2.03], P = .478), hypotension (RR 0.40 [95% CI: 0.14-1.12], P = .056), or other adverse events (RR 1.24 [95% CI: 0.01-247.13], P = .694). For antazoline vs amiodarone, conversion to sinus rhythm favored antazoline (RR 1.22 [95% CI: 1.08-1.36], P = .018, I2 = 0%), with no significant differences in bradycardia (RR 1.36 [95% CI: 0-1072357.09], P = .823) or hypotension (RR 1.05 [95% CI: 0.04-26.16], P = .877).
Antazoline might be more effective than propafenone and amiodarone in achieving sinus rhythm in AF, with no significant differences in safety outcomes.
The methodology of this systematic review and meta-analysis adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search was conducted in ScienceDirect, Embase, PubMed, and Cochrane Library from inception to April 2025, including citation and reference screening. Statistical analyses were performed using R version 2025.05.0 + 496.
From 172 records, 5 studies comparing antazoline with propafenone (n = 5) or amiodarone (n = 3) for AF were included. For antazoline vs propafenone, conversion to sinus rhythm favored antazoline (risk ratio [RR] 1.13 [95% confidence interval (CI): 1.04-1.23], P = .017). No significant difference was observed in time to conversion (mean difference -10.98 [95% CI: -124.93-102.98], P = .436), bradycardia (RR 0.84 [95% CI: 0.35-2.03], P = .478), hypotension (RR 0.40 [95% CI: 0.14-1.12], P = .056), or other adverse events (RR 1.24 [95% CI: 0.01-247.13], P = .694). For antazoline vs amiodarone, conversion to sinus rhythm favored antazoline (RR 1.22 [95% CI: 1.08-1.36], P = .018, I2 = 0%), with no significant differences in bradycardia (RR 1.36 [95% CI: 0-1072357.09], P = .823) or hypotension (RR 1.05 [95% CI: 0.04-26.16], P = .877).
Antazoline might be more effective than propafenone and amiodarone in achieving sinus rhythm in AF, with no significant differences in safety outcomes.
Authors
Bakht Bakht, Arham Arham, Yousaf Yousaf, Amir Amir, Baloch Baloch, Munir Munir, Batool Batool, Gulzar Gulzar, Rashid Rashid, Bokhari Bokhari, Awais Awais, Bakht Bakht, Haris Haris, Saleem Saleem, Saad Saad
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