Mead G E, Elder A T, Flapan A D, Kelman A
Clinical and Surgical Sciences, University of Edinburgh, Chancellor's Building, New Royal Infirmary, Little France Crescent, Edinburgh, UK, EH16 4SB.
Cochrane Database Syst Rev. 2005 Jul 20(3):CD002903. doi: 10.1002/14651858.CD002903.pub2.
Atrial fibrillation increases stroke risk and adversely affects cardiovascular haemodynamics. Electrical cardioversion may, by restoring sinus rhythm, improve cardiovascular haemodynamics, reduce the risk of stroke, and obviate the need for long-term anticoagulation.
To assess the effects of electrical cardioversion of atrial fibrillation or flutter on the risk of thromboembolic events, strokes and mortality (primary outcomes), the rate of cognitive decline, quality of life, the use of anticoagulants and the risk of re-hospitalisation (secondary outcomes) in adults (>18 years).
We searched the Cochrane CENTRAL Register of Controlled Trials (1967 to May 2004), MEDLINE (1966 to May 2004), Embase (1980 to May 2004), CINAHL (1982 to May 2004), proceedings of the American College of Cardiology (published in Journal of the American College of Cardiology 1983 to 2003), www.trialscentral.org, www.controlled-trials.com and reference lists of articles. We hand-searched the indexes of the Proceedings of the British Cardiac Society published in British Heart Journal (1980 to 1995) and in Heart (1995 to 2002); proceedings of the European Congress of Cardiology and meetings of the Joint Working Groups of the European Society of Cardiology (published in European Heart Journal 1983-2003); scientific sessions of the American Heart Association (published in Circulation 1990-2003). Personal contact was made with experts.
Randomised controlled trial or controlled clinical trials of electrical cardioversion plus 'usual care' versus 'usual care' only, where 'usual care' included any combination of anticoagulants, antiplatelet drugs and drugs for 'rate control'. We excluded trials which used pharmacological cardioversion as the first intervention, and trials of new onset atrial fibrillation after cardiac surgery. There were no language restrictions.
For dichotomous data, odds ratios were calculated; and for continuous data, the weighted mean difference was calculated.
We found three completed trials of electrical cardioversion (rhythm control) versus rate control, recruiting a total of 927 participants (Hot Cafe; RACE; STAF) and one ongoing trial (J-RHYTHM). There was no difference in mortality between the two strategies (OR 0.83; CI 0.48 to 1.43). There was a trend towards more strokes in the rhythm control group (OR 1.9; 95% CI 0.99 to 3.64). At follow up, three domains of quality of life (physical functioning, physical role function and vitality) were significantly better in the rhythm control group (RACE 2002; STAF 2003).
AUTHORS' CONCLUSIONS: Electrical cardioversion (rhythm control) led to a non-significant increase in stroke risk but improved three domains of quality of life.
心房颤动会增加中风风险，并对心血管血流动力学产生不利影响。电复律通过恢复窦性心律，可能改善心血管血流动力学、降低中风风险，并避免长期抗凝治疗的必要性。
评估成人（>18岁）心房颤动或心房扑动电复律对血栓栓塞事件、中风和死亡率（主要结局）、认知功能下降率、生活质量、抗凝剂使用情况以及再次住院风险（次要结局）的影响。
我们检索了Cochrane对照试验中心注册库（1967年至2004年5月）、MEDLINE（1966年至2004年5月）、Embase（1980年至2004年5月）、CINAHL（1982年至2004年5月）、美国心脏病学会会议记录（发表于《美国心脏病学会杂志》1983年至2003年）、www.trialscentral.org、www.controlled-trials.com以及文章的参考文献列表。我们手工检索了发表于《英国心脏杂志》（1980年至1995年）和《心脏》（1995年至2002年）的英国心脏病学会会议记录索引；欧洲心脏病学会会议记录以及欧洲心脏病学会联合工作组会议记录（发表于《欧洲心脏杂志》1983 - 2003年）；美国心脏协会科学会议记录（发表于《循环》1990 - 2003年）。与专家进行了个人联系。
电复律加“常规治疗”与仅“常规治疗”的随机对照试验或对照临床试验，其中“常规治疗”包括抗凝剂、抗血小板药物和“心率控制”药物的任何组合。我们排除了以药物复律作为首次干预的试验以及心脏手术后新发心房颤动的试验。没有语言限制。
对于二分数据，计算比值比；对于连续数据，计算加权平均差。
我们发现三项关于电复律（节律控制）与心率控制的完成试验，共招募了927名参与者（Hot Cafe；RACE；STAF）以及一项正在进行的试验（J - RHYTHM）。两种策略之间的死亡率没有差异（比值比0.83；可信区间0.48至1.43）。节律控制组有更多中风的趋势（比值比1.9；95%可信区间0.99至3.64）。在随访时，节律控制组的三个生活质量领域（身体功能、身体角色功能和活力）明显更好（RACE 2002；STAF 2003）。
电复律（节律控制）导致中风风险非显著增加，但改善了三个生活质量领域。
