Editor’s Capsule Summary
What is already known on this topic
Multiple trials have evaluated the effectiveness of pharmacologic agents for cardioversion of recent-onset atrial fibrillation or flutter in the emergency department. Network meta-analysis can provide indirect comparisons between agents even when direct comparisons have not been undertaken.
What question this study addressed
Which drug is most effective for pharmacologic cardioversion within 4 hours of recent-onset atrial fibrillation or flutter?
What this study adds to our knowledge
Six agents were associated with conversion within 4 hours compared with placebo or control, but limitations of the available data meant that network meta-analysis could not reliably identify the most effective agent or agents.
How this is relevant to clinical practice
There is insufficient evidence to guide practice. Further research is required, perhaps involving a multistage multiarm design to allow robust comparison of multiple agents.