Nergårdh Anna K, Rosenqvist Mårten, Nordlander Rolf, Frick Mats
Department of Cardiology, Karolinska Institutet at Stockholm South Hospital, Stockholm S-118 83, Sweden.
Eur Heart J. 2007 Jun;28(11):1351-7. doi: 10.1093/eurheartj/ehl544. Epub 2007 Feb 28.
To assess the effect of metoprolol in combination with repeated cardioversion on maintenance of sinus rhythm (SR).
Consecutive outpatients with persistent atrial fibrillation (AF) were randomized to treatment with metoprolol CR or placebo in a double-blind fashion. Study treatment was started at least one week before direct current (DC) cardioversion. Patients were followed once a week during the first 6 weeks after cardioversion. In case of relapse during this period, a second cardioversion was performed. Total treatment time was 6 months. A total of 168 patients were randomized to metoprolol (n = 83) or placebo (n = 85). The dose of study treatment at cardioversion was 169 +/- 47 mg in the metoprolol group and 180 +/- 40 mg in the placebo group (P = 0.12). In an intention-to-treat analysis, 46 patients (55%) in the metoprolol group and 34 patients (40%) in the placebo group (P = 0.04) had SR 1 week after cardioversion, and 38 patients (46%) in the metoprolol group compared with 22 patients (26%) in the placebo group had SR after 6 months (P < 0.01).
A treatment strategy of metoprolol CR started before cardioversion in combination with prompt second cardioversion in case of early relapse (1-6 weeks) significantly increases the proportion of patients in SR during six months of follow-up.
评估美托洛尔联合重复心脏复律对维持窦性心律（SR）的效果。
持续性心房颤动（AF）的连续门诊患者以双盲方式随机接受美托洛尔缓释片或安慰剂治疗。研究治疗在直流电（DC）心脏复律前至少1周开始。心脏复律后的前6周，患者每周随访1次。在此期间若复发，则进行第二次心脏复律。总治疗时间为6个月。共有168例患者被随机分为美托洛尔组（n = 83）或安慰剂组（n = 85）。心脏复律时研究治疗的剂量在美托洛尔组为169±47mg，在安慰剂组为180±40mg（P = 0.12）。在意向性分析中，美托洛尔组46例患者（55%）和安慰剂组34例患者（40%）在心脏复律后1周维持窦性心律（P = 0.04），美托洛尔组38例患者（46%）与安慰剂组22例患者（26%）在6个月后维持窦性心律（P < 0.01）。
心脏复律前开始使用美托洛尔缓释片并在早期复发（1 - 6周）时及时进行第二次心脏复律的治疗策略，在6个月的随访期间显著提高了维持窦性心律患者的比例。
