Home›Cardiology› Antazoline May Beat Propafenone and Amiodarone for AF Conversion
Antazoline May Beat Propafenone and Amiodarone for AF ConversionAntazoline shows better results for atrial fibrillation heart rhythms
New England Journal of MedicinePublished July 26, 2026Study authors: Bakht Danyal, Arham Muhammad, Yousaf Faiza, Amir Maaz, Baloch Maha Akbar, Munir Tooba, Batool Farwa,…PubMed ↗DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Antazoline may be more effective than propafenone or amiodarone for converting AF to sinus rhythm, with no significant safety differences.
A meta-analysis of eight studies compared antazoline with propafenone (five studies) and amiodarone (three studies) for conversion of atrial fibrillation (AF) to sinus rhythm. The analysis found that antazoline significantly increased the likelihood of conversion compared to propafenone (RR 1.13, 95% CI 1.04-1.23, P =.017) and amiodarone (RR 1.22, 95% CI 1.08-1.36, P =.018, I² = 0%).
Time to conversion did not differ significantly between antazoline and propafenone (mean difference -10.98 minutes, 95% CI -124.93 to 102.98, P =.436). Safety outcomes, including bradycardia and hypotension, showed no significant differences between antazoline and either comparator. For antazoline versus propafenone, bradycardia (RR 0.84, 95% CI 0.35-2.03, P =.478) and hypotension (RR 0.40, 95% CI 0.14-1.12, P =.056) were similar. Against amiodarone, bradycardia (RR 1.36, 95% CI 0-1072357.09, P =.823) and hypotension (RR 1.05, 95% CI 0.04-26.16, P =.877) also showed no significant differences.
These findings suggest antazoline may be a more effective option for acute conversion of AF, with a safety profile comparable to propafenone and amiodarone. However, the analysis is limited by the small number of studies and limited direct comparative evidence against standard antiarrhythmic agents. Further research is needed to confirm these results and assess long-term outcomes.
How this fits prior evidence
This meta-analysis addresses gaps in the comparison of specific antiarrhythmic drugs for atrial fibrillation. While previous evidence notes that rhythm control increases sinus rhythm conversion odds but also elevates risks of medication side effects, this study suggests antazoline may be more effective than propafenone and amiodarone for conversion without significant differences in bradycardia or hypotension. It does not directly relate to the findings regarding catheter ablation or pulsed field ablation.
Living with atrial fibrillation (AF) can feel like your heart is constantly out of sync. For many, the goal is to get the heart back into a steady, normal rhythm called sinus rhythm. A recent review of eight studies looked at how different medications help achieve this goal.
The researchers compared antazoline against two other common drugs: propafenone and amiodarone. The results showed that patients taking antazoline were more likely to reach a normal heart rhythm than those taking either propafenone or amiodarone. While the time it took to reach that steady rhythm did not differ significantly between groups, the success rate for antazoline was higher.
Safety is a major concern when treating heart conditions. In this review, there were no significant differences in common side effects like bradycardia (a slow heart rate) or hypotension (low blood pressure) between the medications. However, it is important to note that the evidence comparing these drugs directly is still limited, so patients should talk to their doctor about which treatment fits their specific needs.
What this means for you:
Antazoline may be more effective than propafenone or amiodarone at restoring normal heart rhythms in AF patients.
Common questions
Is antazoline more effective for atrial fibrillation?
Yes, the review of eight studies found that antazoline was more likely to help patients achieve sinus rhythm compared to both propafenone and amiodarone. While it showed better results in reaching a normal heart rhythm, there were no significant differences in how quickly the conversion happened.
Are there safety concerns with using antazoline?
The study found no significant differences in common side effects like bradycardia (slow heart rate) or hypotension (low blood pressure) when comparing antazoline to propafenone or amiodarone. Because the evidence for direct comparisons is limited, you should discuss your specific safety profile with a doctor.
How does antazoline compare to other common medications?
When compared to propafenone and amiodarone, antazoline showed a higher rate of success in restoring sinus rhythm. However, the study did not find significant differences in other areas, such as the time it took to reach a normal rhythm or the occurrence of other adverse events.
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSION: Antazoline might be more effective than propafenone and amiodarone in achieving sinus rhythm in AF, with no significant differences in safety outcomes.
