Nasr Imad Abi, Bouzamondo Anissa, Hulot Jean-Sébastien, Dubourg Olivier, Le Heuzey Jean-Yves, Lechat Philippe
Clinical Pharmacology Department, La Pitié Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, 47 Boulevard de l'Hôpital, 75013 Paris, and Cardiology Department, Hôpital Universitaire Ambroise Paré, Boulogne, France.
Eur Heart J. 2007 Feb;28(4):457-62. doi: 10.1093/eurheartj/ehl484. Epub 2007 Feb 8.
Atrial fibrillation (AF) is an important morbidity-mortality risk factor, especially in patients with heart failure (HF). Beta-blockers reduce morbidity and mortality in HF. The study was designed to estimate the preventive efficacy of beta-blocker treatment on AF occurrence in patients with HF.
A systematic review of the literature was performed to identify all clinical trials evaluating beta-blockers' efficacy in HF. Eligible studies had to be randomized, placebo-controlled and providing information on the incidence of AF during follow-up among those with sinus rhythm at baseline. A total of seven studies which included 11 952 patients receiving a background treatment with angiotensin-converting enzyme-inhibitors could be found. Overall, beta-blockers significantly reduced incidence of onset of AF from 39 to 28 per 1000 patient-years: relative risk reduction=27% (95% confidence interval 14-38, P<0.001); heterogeneity test: P=0.096. A same trend of efficacy was observed in all trials except the SENIORS study. In this trial which included aged patients (>70 years) with systolic or diastolic HF, a higher prevalence of AF at baseline (35%) was observed compared with the mean baseline prevalence (13%).
Beta-blockers appear to effectively prevent occurrence of AF in patients with systolic HF.
心房颤动（AF）是一个重要的发病 - 死亡风险因素，尤其在心力衰竭（HF）患者中。β受体阻滞剂可降低HF患者的发病率和死亡率。本研究旨在评估β受体阻滞剂治疗对HF患者AF发生的预防效果。
对文献进行系统回顾，以确定所有评估β受体阻滞剂在HF中疗效的临床试验。符合条件的研究必须是随机、安慰剂对照的，并且要提供基线时窦性心律患者随访期间AF发生率的信息。共找到7项研究，包括11952例接受血管紧张素转换酶抑制剂背景治疗的患者。总体而言，β受体阻滞剂使AF的发病发生率从每1000患者年39例显著降低至28例：相对风险降低 = 27%（95%置信区间14 - 38，P < 0.001）；异质性检验：P = 0.096。除SENIORS研究外，所有试验均观察到相同的疗效趋势。在这项纳入收缩期或舒张期HF老年患者（>70岁）的试验中，与平均基线患病率（13%）相比，观察到基线时AF患病率更高（35%）。
β受体阻滞剂似乎能有效预防收缩期HF患者发生AF。
