human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM The aim of the present study was to compare the safety and efficacy of amiodarone and procainamide in the acute cardiology setting . METHODS The study population consisted of 223 patients with symptomatic atrial fibrillation ( AF ) . After administration of digoxin for ventricular rate control , all patients who failed to restore sinus rhythm ( SR ) were r and omized into 2 groups : group A ( 113 patients ) were administered 300 mg amiodarone intravenously over 30 min and , in case of failure to restore SR , amiodarone of 20 mg/kg/24 h was administered intravenously . Group B ( 110 patients ) were intravenously administered a bolus dose of 1 gm procainamide , at an infusion rate 50/mg/min , and , in case of failure to restore SR , 2 mg/min for the next 24 h. RESULTS The rate of cardioversion to SR was similar between amiodarone ( 81.4 % ) and procainamide ( 82.7 % ) ( P = NS ) . Procainamide loading recorded faster cardioversion times than amiodarone loading ( P=0.02 ) , but there was no significant difference after that . Amiodarone caused a significant decrease on systolic blood pressure compared to procainamide for the first 18 h ( P<0.001 ) , and a significant decrease in the diastolic blood pressure for the first 6 h ( P<0.001 ) . Side-effects for either medication were sparse . The only real prognostic factor for successful cardioversion remains the size of left atrium . CONCLUSION Both drugs were equally effective in restoring SR , though procainamide acts quicker in the loading phase . Both medications are safe and side effects develop only in the maintenance phase Background Indirect comparisons are becoming increasingly popular for evaluating medical treatments that have not been compared head-to-head in r and omized clinical trials ( RCTs ) . While indirect methods have grown in popularity and acceptance , little is known about the fragility of confidence interval estimations and hypothesis testing relying on this method . Methods We present the findings of a simulation study that examined the fragility of indirect confidence interval estimation and hypothesis testing relying on the adjusted indirect method . Findings Our results suggest that , for the setting s considered in this study , indirect confidence interval estimation suffers from under-coverage while indirect hypothesis testing suffers from low power in the presence of moderate to large between- study heterogeneity . In addition , the risk of overestimation is large when the indirect comparison of interest relies on just one trial for one of the two direct comparisons . Interpretation Indirect comparisons typically suffer from low power . The risk of imprecision is increased when comparisons are unbalanced BACKGROUND A prospect i ve , r and omized study was conducted to evaluate the efficacy and tolerability of oral propafenone and quinidine for the conversion of paroxysmal atrial fibrillation ( AF ) . METHODS Eighty one consecutive patients ( female/male 46/35 ; mean age 64.0 + /- 11.6 ) , admitted to hospital with AF lasting no longer than 48 hours , were r and omized in terms of their pharmacological therapy . Forty three patients ( 55 % ) were r and omly assigned to Group I and received propafenone 600 mg orally as the initial therapy , with an additional dose of 300 mg after eight hours , if the sinus rhythm had not been restored by then . Thirty eight patients ( 45 % ) ( Group II ) received 1 mg digoxin IV followed by an oral loading of quinidine ( 400 mg followed by 200 mg every two hours ) . RESULTS The conversion rate assessed after 24 hours was the same in both groups ( Gr . I vs. Gr . II : 90.7 vs. 91.4 % ) , with the same number of mild side effects ( Gr . I vs. Gr . II : 37.2 % vs. 45.7 % ) . No life-threatening adverse events were reported . Propafenone achieved a higher efficacy rate during the first eight hours ( 83.3 vs. 54.3 % ; p = 0.01 ) , with a significantly shorter time required to sinus rhythm recovery throughout the study period , with a median time of 165 min ( 95 % confidence interval 120 - 278 ) vs. 360 min ( 95 % confidence interval 298 - 650 ; p < 0.05 ) . There was some indication of greater effectiveness of propafenone than quinidine in early sinus rhythm restoration in patients with : no structural heart disease , in those with an AF duration shorter than 12 hours , and in patients with an ejection fraction > 55 % . CONCLUSIONS Although both drugs revealed the same effectiveness , the conversion to sinus rhythm in the group treated with propafenone was observed more quickly despite the longer paroxysmal AF episode duration BACKGROUND Drugs currently available for the acute treatment of paroxysmal atrial fibrillation have significant limitations . We assessed the safety and effectiveness of intravenous magnesium sulfate versus diltiazem therapy in patients with prolonged episodes of paroxysmal atrial fibrillation . METHODS In a prospect i ve r and omized trial , 46 symptomatic patients presenting with paroxysmal atrial fibrillation were given intravenous magnesium sulfate ( n=23 ) or diltiazem ( n=23 ) therapy . Primary outcome measures were effects on ventricular rate control and proportion of patients restored to sinus rhythm at 6 h after initiation of treatment . RESULTS There were no differences in baseline characteristics between the two groups . Both forms of treatment were well tolerated , with no adverse clinical events . Both drugs had similar efficacy in reducing the ventricular rate at the first hour of treatment ( P<0.05 ) with a tendency toward a further decrease during infusion times of 2 ( P<0.01 ) , 3 , 4 , 5 and 6 h , respectively ( P<0.001 ) . However , at the end of the 6-h treatment period , restoration of sinus rhythm was observed in a significantly higher proportion of patients in the magnesium group compared with the diltiazem group [ 13 of 23 patients , ( 57 % ) , versus five of 23 patients , ( 22 % ) , P=0.03 ] . CONCLUSIONS Magnesium sulfate favorably affects rate control and seems to promote the conversion of long lasting episodes of paroxysmal atrial fibrillation to sinus rhythm , representing a safe , reliable and cost-effective alternative treatment strategy to diltiazem AIM The aim of our study was to compare the efficacy and safety of ibutilide and amiodarone ( intravenously ) in converting  recent-onset atrial fibrillation ( AF ) and atrial flutter ( Af )  to sinus rhythm ( SR ) . METHODS The study was prospect i ve , r and omized and included 152 ( 103 men and 49 women ) consecutive patients with AF or Af of 3 - 48 h duration .  Ibutilide is a selective class III antiarrhythmic agent which when administered intravenously can terminate AF and Af .  Amiodarone is also a class III antiarrhythmic agent that when given intravenously or orally has proved to be more effective than other agents in terminating AF and Af [ B.N. Singh , F.V. Mody , B. Lopez , J.S. Sarma . Antiarrhythmic agents for atrial fibrillation : focus on prolonging atrial repolarization . Am J Cardiol 1999 Nov 4 ; 84 : 161R-173R . ] . Seventy-nine patients ( 56 with AF and 23 with Af ) that consisted group A were treated with ibutilide .  Seventy-three ( 52 with AF and 21 with Af ) consisted group B and were treated with intravenous infusion of amiodarone . RESULTS The conversion rate of group A ( ibutilide ) was significantly higher than the conversion rate of group B ( amiodarone ) ( 80 % vs. 57 % , p=0.0054 ) . As regards the kind of arrhythmia separately , for AF there was n't significant difference ( 77 % vs. 69 % , p = ns ) whereas for Af ibutilide was superior to amiodarone ( 87 % vs. 29 % , p=0.003 ) . The conversion rates of ibutilide did n't differ for AF and Af ( 77 % vs. 87 % , p = ns ) . CONCLUSIONS Ibutilide is more effective than amiodarone in converting recent-onset Af to SR whereas both drugs are equally effective in converting recent-onset AF to SR Introduction Emergency department ( ED ) cardioversion ( EDCV ) and discharge of patients with recent onset atrial fibrillation or atrial flutter ( AF ) has been shown to be a safe and effective management strategy . This study examines the impact of such aggressive ED management on hospital charges . Methods : A r and om sample of 300 AF patients were identified from an ED electronic data base and screened for timing of onset of their symptoms . Patients were considered eligible for EDCV if either nursing or physician notes documented an onset of symptoms less than 48 hours prior to ED presentation and the patient was less than 85 years of age . An explicit chart review was then performed to determine patient management and disposition . Cardioversion attempts were defined as ED administration of procainamide , flecainide , propafenone , ibutilide , amiodarone or direct current cardioversion ( DCCV ) .  Total hospital charges for each patient were obtained from the hospital billing office . Differences across medians were analyzed utilizing through Wilcoxon rank sum tests and chi square . Results : A total of 51 patients were included in the study .  EDCV  was attempted on 24 ( 47 % ) patients , 22 ( 92 % ) were successfully cardioverted to normal sinus rhythm ( NSR ) . An additional 12 ( 23 % ) spontaneously converted to NSR . Twenty ( 91 % ) of those successfully cardioverted were discharged from the ED along with 4 ( 33 % ) of those spontaneously converting . Pharmacologic cardioverson was attempted in six patients and was successful in three ( 50 % ) , one after failed DCCV attempt .  Direct current cardioversion  was attempted in 21 ( 88 % ) and was successful in 19 ( 90 % ) , two after failed pharmacologic attempts . Median charges for patients cardioverted and discharged from the ED were $ 5,460 ( IQR $ 4,677–$6,190 ) . Median charges for admitted patients with no attempt at cardioversion were $ 23,202 ( IQR $ 19,663–$46,877 ) . Median charges for patients whose final ED rhythm was NSR were $ 5,641 ( IQR $ 4,638–$12,339 ) while for those remaining inAF median charges were $ 30,299 ( IQR $ 20,655 – $ 69,759 ) . Conclusion : ED cardioversion of recent onset AF patients results in significant hospital savings OBJECTIVE To investigate whether an oral loading dose of flecainide is as safe and effective as intravenous flecainide for the cardioversion of acute atrial fibrillation . DESIGN Prospect i ve , r and omised , double blind , double placebo study . SETTING Cardiac care unit of a large district general hospital in the UK . PATIENTS AND METHODS 79 patients presenting with symptomatic acute atrial fibrillation : patients were given either intravenous flecainide ( n = 39 ) or a solution of oral flecainide ( n = 40 ) , with appropriate placebos . All patients were heparinised during the study . PRIMARY OUTCOME MEASURES Safety ; mean time to cardioversion ; proportion of patients restored to sinus rhythm at two hours and eight hours after treatment . Analysis was by intention to treat . RESULTS There were no differences in baseline characteristics between the oral and intravenous groups . Both forms of flecainide were well tolerated , with no adverse clinical events during the study . The mean time to cardioversion was 110 minutes in the oral group and 52 minutes in the intravenous group ( p = 0.002 ) . Two hours after treatment , 27 of the 40 patients in the oral group ( 68 % ) and 25 of the 39 in the intravenous group ( 64 % ) had reverted to sinus rhythm ( p = 0.74 ) . Eight hours after treatment , 30 patients in the oral group ( 75 % ) and 28 in the intravenous group ( 72 % ) had reverted to sinus rhythm ( p = 0.76 ) . CONCLUSIONS Intravenous flecainide restored sinus rhythm more rapidly than oral flecainide , but at two hours and eight hours after treatment there was no difference in the proportion of patients cardioverted by the two approaches . These results suggest a role for oral loading doses of flecainide in the treatment of acute or symptomatic paroxysmal atrial fibrillation The appropriate treatment for the restoration of sinus rhythm in patients with atrial fibrillation ( AF ) of recent onset is still the subject of controversy . In this prospect i ve , r and omized , single-blind , placebo-controlled clinical study , we investigated the effectiveness and safety of procainamide , propafenone , and amiodarone , administered intravenously , for the conversion of recent-onset AF . We enrolled 362 consecutive patients ( 183 men ; age 34 to 86 years ; mean 65+/-10 ) with AF duration of no > 48 hours . Of these patients , 89 were given procainam 
    Output:
    
agent
Bayesian network meta- analysis using a r and om-effects model demonstrated that ranolazine + amiodarone intravenous ( IV ) [ odds ratio ( OR ) 39.8 , 95 % credible interval ( CrI ) 8.3 - 203.1 ] , vernakalant ( OR 22.9 , 95 % CrI 3.7 - 146.3 ) , flecainide ( OR 16.9 , 95 % CrI 4.1 - 73.3 ) , amiodarone oral ( OR 10.2 , 95 % CrI 3.1 - 36.0 ) , ibutilide ( OR 7.9 , 95 % CrI 1.2 - 52.5 ) , amiodarone IV ( OR 5.4 , 95 % CrI 2.1 - 14.6 ) , and propafenone ( OR 4.1 , 95 % CrI 1.7 - 10.5 ) were associated with significantly increased likelihood of conversion within 24 h when compared to placebo/control .
Probabilistic analysis ranked vernakalant and flecainide high and propafenone and amiodarone IV low .
For pharmacologic cardioversion of recent-onset AF within 24 h , there is insufficient evidence to determine which treatment is superior .
Vernakalant and flecainide may be relatively more efficacious agents .
Propafenone and IV amiodarone may be relatively less efficacious .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM The aim of the present study was to compare the safety and efficacy of amiodarone and procainamide in the acute cardiology setting . METHODS The study population consisted of 223 patients with symptomatic atrial fibrillation ( AF ) . After administration of digoxin for ventricular rate control , all patients who failed to restore sinus rhythm ( SR ) were r and omized into 2 groups : group A ( 113 patients ) were administered 300 mg amiodarone intravenously over 30 min and , in case of failure to restore SR , amiodarone of 20 mg/kg/24 h was administered intravenously . Group B ( 110 patients ) were intravenously administered a bolus dose of 1 gm procainamide , at an infusion rate 50/mg/min , and , in case of failure to restore SR , 2 mg/min for the next 24 h. RESULTS The rate of cardioversion to SR was similar between amiodarone ( 81.4 % ) and procainamide ( 82.7 % ) ( P = NS ) . Procainamide loading recorded faster cardioversion times than amiodarone loading ( P=0.02 ) , but there was no significant difference after that . Amiodarone caused a significant decrease on systolic blood pressure compared to procainamide for the first 18 h ( P<0.001 ) , and a significant decrease in the diastolic blood pressure for the first 6 h ( P<0.001 ) . Side-effects for either medication were sparse . The only real prognostic factor for successful cardioversion remains the size of left atrium . CONCLUSION Both drugs were equally effective in restoring SR , though procainamide acts quicker in the loading phase . Both medications are safe and side effects develop only in the maintenance phase Background Indirect comparisons are becoming increasingly popular for evaluating medical treatments that have not been compared head-to-head in r and omized clinical trials ( RCTs ) . While indirect methods have grown in popularity and acceptance , little is known about the fragility of confidence interval estimations and hypothesis testing relying on this method . Methods We present the findings of a simulation study that examined the fragility of indirect confidence interval estimation and hypothesis testing relying on the adjusted indirect method . Findings Our results suggest that , for the setting s considered in this study , indirect confidence interval estimation suffers from under-coverage while indirect hypothesis testing suffers from low power in the presence of moderate to large between- study heterogeneity . In addition , the risk of overestimation is large when the indirect comparison of interest relies on just one trial for one of the two direct comparisons . Interpretation Indirect comparisons typically suffer from low power . The risk of imprecision is increased when comparisons are unbalanced BACKGROUND A prospect i ve , r and omized study was conducted to evaluate the efficacy and tolerability of oral propafenone and quinidine for the conversion of paroxysmal atrial fibrillation ( AF ) . METHODS Eighty one consecutive patients ( female/male 46/35 ; mean age 64.0 + /- 11.6 ) , admitted to hospital with AF lasting no longer than 48 hours , were r and omized in terms of their pharmacological therapy . Forty three patients ( 55 % ) were r and omly assigned to Group I and received propafenone 600 mg orally as the initial therapy , with an additional dose of 300 mg after eight hours , if the sinus rhythm had not been restored by then . Thirty eight patients ( 45 % ) ( Group II ) received 1 mg digoxin IV followed by an oral loading of quinidine ( 400 mg followed by 200 mg every two hours ) . RESULTS The conversion rate assessed after 24 hours was the same in both groups ( Gr . I vs. Gr . II : 90.7 vs. 91.4 % ) , with the same number of mild side effects ( Gr . I vs. Gr . II : 37.2 % vs. 45.7 % ) . No life-threatening adverse events were reported . Propafenone achieved a higher efficacy rate during the first eight hours ( 83.3 vs. 54.3 % ; p = 0.01 ) , with a significantly shorter time required to sinus rhythm recovery throughout the study period , with a median time of 165 min ( 95 % confidence interval 120 - 278 ) vs. 360 min ( 95 % confidence interval 298 - 650 ; p < 0.05 ) . There was some indication of greater effectiveness of propafenone than quinidine in early sinus rhythm restoration in patients with : no structural heart disease , in those with an AF duration shorter than 12 hours , and in patients with an ejection fraction > 55 % . CONCLUSIONS Although both drugs revealed the same effectiveness , the conversion to sinus rhythm in the group treated with propafenone was observed more quickly despite the longer paroxysmal AF episode duration BACKGROUND Drugs currently available for the acute treatment of paroxysmal atrial fibrillation have significant limitations . We assessed the safety and effectiveness of intravenous magnesium sulfate versus diltiazem therapy in patients with prolonged episodes of paroxysmal atrial fibrillation . METHODS In a prospect i ve r and omized trial , 46 symptomatic patients presenting with paroxysmal atrial fibrillation were given intravenous magnesium sulfate ( n=23 ) or diltiazem ( n=23 ) therapy . Primary outcome measures were effects on ventricular rate control and proportion of patients restored to sinus rhythm at 6 h after initiation of treatment . RESULTS There were no differences in baseline characteristics between the two groups . Both forms of treatment were well tolerated , with no adverse clinical events . Both drugs had similar efficacy in reducing the ventricular rate at the first hour of treatment ( P<0.05 ) with a tendency toward a further decrease during infusion times of 2 ( P<0.01 ) , 3 , 4 , 5 and 6 h , respectively ( P<0.001 ) . However , at the end of the 6-h treatment period , restoration of sinus rhythm was observed in a significantly higher proportion of patients in the magnesium group compared with the diltiazem group [ 13 of 23 patients , ( 57 % ) , versus five of 23 patients , ( 22 % ) , P=0.03 ] . CONCLUSIONS Magnesium sulfate favorably affects rate control and seems to promote the conversion of long lasting episodes of paroxysmal atrial fibrillation to sinus rhythm , representing a safe , reliable and cost-effective alternative treatment strategy to diltiazem AIM The aim of our study was to compare the efficacy and safety of ibutilide and amiodarone ( intravenously ) in converting  recent-onset atrial fibrillation ( AF ) and atrial flutter ( Af )  to sinus rhythm ( SR ) . METHODS The study was prospect i ve , r and omized and included 152 ( 103 men and 49 women ) consecutive patients with AF or Af of 3 - 48 h duration .  Ibutilide is a selective class III antiarrhythmic agent which when administered intravenously can terminate AF and Af .  Amiodarone is also a class III antiarrhythmic agent that when given intravenously or orally has proved to be more effective than other agents in terminating AF and Af [ B.N. Singh , F.V. Mody , B. Lopez , J.S. Sarma . Antiarrhythmic agents for atrial fibrillation : focus on prolonging atrial repolarization . Am J Cardiol 1999 Nov 4 ; 84 : 161R-173R . ] . Seventy-nine patients ( 56 with AF and 23 with Af ) that consisted group A were treated with ibutilide .  Seventy-three ( 52 with AF and 21 with Af ) consisted group B and were treated with intravenous infusion of amiodarone . RESULTS The conversion rate of group A ( ibutilide ) was significantly higher than the conversion rate of group B ( amiodarone ) ( 80 % vs. 57 % , p=0.0054 ) . As regards the kind of arrhythmia separately , for AF there was n't significant difference ( 77 % vs. 69 % , p = ns ) whereas for Af ibutilide was superior to amiodarone ( 87 % vs. 29 % , p=0.003 ) . The conversion rates of ibutilide did n't differ for AF and Af ( 77 % vs. 87 % , p = ns ) . CONCLUSIONS Ibutilide is more effective than amiodarone in converting recent-onset Af to SR whereas both drugs are equally effective in converting recent-onset AF to SR Introduction Emergency department ( ED ) cardioversion ( EDCV ) and discharge of patients with recent onset atrial fibrillation or atrial flutter ( AF ) has been shown to be a safe and effective management strategy . This study examines the impact of such aggressive ED management on hospital charges . Methods : A r and om sample of 300 AF patients were identified from an ED electronic data base and screened for timing of onset of their symptoms . Patients were considered eligible for EDCV if either nursing or physician notes documented an onset of symptoms less than 48 hours prior to ED presentation and the patient was less than 85 years of age . An explicit chart review was then performed to determine patient management and disposition . Cardioversion attempts were defined as ED administration of procainamide , flecainide , propafenone , ibutilide , amiodarone or direct current cardioversion ( DCCV ) .  Total hospital charges for each patient were obtained from the hospital billing office . Differences across medians were analyzed utilizing through Wilcoxon rank sum tests and chi square . Results : A total of 51 patients were included in the study .  EDCV  was attempted on 24 ( 47 % ) patients , 22 ( 92 % ) were successfully cardioverted to normal sinus rhythm ( NSR ) . An additional 12 ( 23 % ) spontaneously converted to NSR . Twenty ( 91 % ) of those successfully cardioverted were discharged from the ED along with 4 ( 33 % ) of those spontaneously converting . Pharmacologic cardioverson was attempted in six patients and was successful in three ( 50 % ) , one after failed DCCV attempt .  Direct current cardioversion  was attempted in 21 ( 88 % ) and was successful in 19 ( 90 % ) , two after failed pharmacologic attempts . Median charges for patients cardioverted and discharged from the ED were $ 5,460 ( IQR $ 4,677–$6,190 ) . Median charges for admitted patients with no attempt at cardioversion were $ 23,202 ( IQR $ 19,663–$46,877 ) . Median charges for patients whose final ED rhythm was NSR were $ 5,641 ( IQR $ 4,638–$12,339 ) while for those remaining inAF median charges were $ 30,299 ( IQR $ 20,655 – $ 69,759 ) . Conclusion : ED cardioversion of recent onset AF patients results in significant hospital savings OBJECTIVE To investigate whether an oral loading dose of flecainide is as safe and effective as intravenous flecainide for the cardioversion of acute atrial fibrillation . DESIGN Prospect i ve , r and omised , double blind , double placebo study . SETTING Cardiac care unit of a large district general hospital in the UK . PATIENTS AND METHODS 79 patients presenting with symptomatic acute atrial fibrillation : patients were given either intravenous flecainide ( n = 39 ) or a solution of oral flecainide ( n = 40 ) , with appropriate placebos . All patients were heparinised during the study . PRIMARY OUTCOME MEASURES Safety ; mean time to cardioversion ; proportion of patients restored to sinus rhythm at two hours and eight hours after treatment . Analysis was by intention to treat . RESULTS There were no differences in baseline characteristics between the oral and intravenous groups . Both forms of flecainide were well tolerated , with no adverse clinical events during the study . The mean time to cardioversion was 110 minutes in the oral group and 52 minutes in the intravenous group ( p = 0.002 ) . Two hours after treatment , 27 of the 40 patients in the oral group ( 68 % ) and 25 of the 39 in the intravenous group ( 64 % ) had reverted to sinus rhythm ( p = 0.74 ) . Eight hours after treatment , 30 patients in the oral group ( 75 % ) and 28 in the intravenous group ( 72 % ) had reverted to sinus rhythm ( p = 0.76 ) . CONCLUSIONS Intravenous flecainide restored sinus rhythm more rapidly than oral flecainide , but at two hours and eight hours after treatment there was no difference in the proportion of patients cardioverted by the two approaches . These results suggest a role for oral loading doses of flecainide in the treatment of acute or symptomatic paroxysmal atrial fibrillation The appropriate treatment for the restoration of sinus rhythm in patients with atrial fibrillation ( AF ) of recent onset is still the subject of controversy . In this prospect i ve , r and omized , single-blind , placebo-controlled clinical study , we investigated the effectiveness and safety of procainamide , propafenone , and amiodarone , administered intravenously , for the conversion of recent-onset AF . We enrolled 362 consecutive patients ( 183 men ; age 34 to 86 years ; mean 65+/-10 ) with AF duration of no > 48 hours . Of these patients , 89 were given procainam 
    Output:
    