Prasai Paritosh, Shrestha Dhan Bahadur, Saad Eltaib, Trongtorsak Angkawipa, Adhikari Aarya, Gaire Suman, Oli Prakash Raj, Shtembari Jurgen, Adhikari Pabitra, Sedhai Yub Raj, Akbar Muhammad Sikander, Elgendy Islam Y, Shantha Ghanshyam
Department of Internal Medicine, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA.
Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA.
J Clin Med. 2023 Feb 1;12(3):1165. doi: 10.3390/jcm12031165.
There is no clear consensus on the preference for pharmacological cardioversion (PC) in comparison to electric cardioversion (EC) for hemodynamically stable new-onset atrial fibrillation (NOAF) patients presenting to the emergency department (ED).
A systematic review and meta-analysis was conducted to assess PC (whether being followed by EC or not) vs. EC in achieving cardioversion for hemodynamically stable NOAF patients. PubMed, PubMed Central, Embase, Scopus, and Cochrane databases were searched to include relevant studies until 7 March 2022. The primary outcome was the successful restoration of sinus rhythm, and secondary outcomes included emergency department (ED) revisits with atrial fibrillation (AF), hospital readmission rate, length of hospital stay, and cardioversion-associated adverse events.
A total of three randomized controlled trials (RCTs) and one observational study were included. There was no difference in the rates of successful restoration to sinus rhythm (88.66% vs. 85.25%; OR 1.14, 95% CI 0.35-3.71; = 868). There was no statistical difference across the two groups for ED revisits with AF, readmission rates, length of hospital stay, and cardioversion-associated adverse effects, with the exception of hypotension, whose incidence was lower in the EC group (OR 0.11, 95% CI 0.04-0.27: = 727).
This meta-analysis suggests that there is no difference in successful restoration of sinus rhythm with either modality among patients with hemodynamically stable NOAF.
对于血流动力学稳定的新发房颤（NOAF）患者到急诊科就诊时，与电复律（EC）相比，药物复律（PC）的偏好尚无明确共识。
进行了一项系统评价和荟萃分析，以评估PC（无论是否随后进行EC）与EC在使血流动力学稳定的NOAF患者复律方面的效果。检索了PubMed、PubMed Central、Embase、Scopus和Cochrane数据库，纳入相关研究至2022年3月7日。主要结局是窦性心律的成功恢复，次要结局包括房颤（AF）导致的急诊科复诊、住院再入院率、住院时间以及复律相关不良事件。
共纳入三项随机对照试验（RCT）和一项观察性研究。窦性心律成功恢复率无差异（88.66%对85.25%；OR 1.14，95%CI 0.35 - 3.71； = 868）。两组在房颤导致的急诊科复诊、再入院率、住院时间和复律相关不良反应方面无统计学差异，但低血压除外，其在EC组的发生率较低（OR 0.11，95%CI 0.04 - 0.27： = 727）。
这项荟萃分析表明，对于血流动力学稳定的NOAF患者，两种方式在窦性心律成功恢复方面无差异。
