Tsiachris Dimitris, Doundoulakis Ioannis, Tsioufis Panagiotis, Pagkalidou Eirini, Antoniou Christos-Konstantinos, Zafeiropoulos Stefanos M, Gatzoulis Konstantinos A, Tsioufis Konstantinos, Stefanadis Christodoulos
Athens Medical Center, Athens Heart Center, Distomou 5-7, 15125, Athens, Greece.
First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece.
Eur J Clin Pharmacol. 2022 Jun;78(6):1039-1045. doi: 10.1007/s00228-022-03296-0. Epub 2022 Feb 22.
The objective of the present systematic review was to compare the effectiveness and safety of class Ic agents for cardioversion of paroxysmal atrial fibrillation (AF), in patients with and without structural heart disease (SHD).
We focused on RCTs enrolling at least 50 adult patients with electrocardiogram-documented paroxysmal AF that compared either two pharmacological class Ic cardioversion agents (flecainide, propafenone), regardless of study design (parallel or crossover). We searched MEDLINE and the Cochrane Central Register of Controlled Trials. Initial search was performed from inception to 15 July 2021 with no language restrictions.
Intravenous flecainide is the most effective option for pharmacologic cardioversion of AF since only 2 patients need to be treated in order to cardiovert one more within 4 h. Most importantly, class Ic agents appear to be safe in the context of pharmacologic cardioversion of AF irrespective of the presence of SHD, pointing towards a possible reappraisal of the role in this setting.
We suggest that class Ic agents (with flecainide appearing to be more effective) should be used for pharmacologic cardioversion in stable AF patients presenting in emergency department with unknown medical history, after excluding severe cardiac disease through a bedside examination.
REGISTRATION NUMBER (DOI): Available in https://osf.io/apwt7/ , https://doi.org/10.17605/OSF.IO/APWT7.
本系统评价的目的是比较Ic类药物对阵发性心房颤动（AF）进行心脏复律时，在有和无结构性心脏病（SHD）患者中的有效性和安全性。
我们重点关注纳入至少50例经心电图证实为阵发性AF的成年患者的随机对照试验（RCT）s，这些试验比较了两种Ic类心脏复律药物（氟卡尼、普罗帕酮），不考虑研究设计（平行或交叉）。我们检索了MEDLINE和Cochrane对照试验中央注册库。初始检索从建库至2021年7月15日，无语言限制。
静脉注射氟卡尼是AF药物复律最有效的选择，因为在4小时内每多复律1例仅需治疗2例患者。最重要的是，无论是否存在SHD，Ic类药物在AF药物复律的情况下似乎都是安全的，这表明在这种情况下可能需要重新评估其作用。
我们建议，对于在急诊科就诊、病史不明的稳定AF患者，在通过床边检查排除严重心脏病后，应使用Ic类药物（氟卡尼似乎更有效）进行药物复律。
注册号（DOI）：可在https://osf.io/apwt7/ ，https://doi.org/10.17605/OSF.IO/APWT7上获取。
