Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, 52242, USA.
Department of General Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Am J Cardiovasc Drugs. 2024 Jan;24(1):103-115. doi: 10.1007/s40256-023-00615-3. Epub 2023 Oct 19.
Atrial fibrillation (AF) and/or atrial flutter (AFL) with rapid ventricular response (RVR) is a condition that often requires urgent treatment. Although guidelines have recommendations regarding chronic rate control therapy, recommendations on the best choice for acute heart rate (HR) control in RVR are unclear.
A systematic search across multiple databases was performed for studies evaluating the outcome of HR control (defined as HR less than 110 bpm and/or 20% decrease from baseline HR). Included studies evaluated AF and/or AFL with RVR in a hospital setting, with direct comparison between intravenous (IV) diltiazem and metoprolol and excluded cardiac surgery and catheter ablation patients. Hypotension (defined as systolic blood pressure less than 90 mmHg) was measured as a secondary outcome. Two authors performed full-text article review and extracted data, with a third author mediating disagreements. Random effects models utilizing inverse variance weighting were used to calculate odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using the I test.
A total of 563 unique titles were identified through the systematic search, of which 16 studies (7 randomized and 9 observational) were included. In our primary analysis of HR control by study type, IV diltiazem was found to be more effective than IV metoprolol for HR control in randomized trials (OR 4.75, 95% CI 2.50-9.04 with I = 14%); however, this was not found for observational studies (OR 1.26, 95% CI 0.89-1.80 with I = 55%). In an analysis of observational studies, there were no significant differences between the two drugs in odds of hypotension (OR 1.12, 95% CI 0.51-2.45 with I = 18%).
While there was a trend toward improved HR control with IV diltiazem compared with IV metoprolol in randomized trials, this was not seen in observational studies, and there was no observed difference in hypotension between the two drugs.
心房颤动（AF）和/或心房扑动（AFL）伴快速心室反应（RVR）是一种常需要紧急治疗的病症。尽管指南对慢性心率控制治疗有建议，但对于 RVR 时急性心率（HR）控制的最佳选择的建议尚不清楚。
对多个数据库进行了系统检索，以评估 HR 控制（定义为 HR 小于 110 次/分和/或比基线 HR 降低 20%）结果的研究。纳入的研究评估了医院环境中的 AF 和/或 AFL 伴 RVR，比较了静脉内（IV）地尔硫卓和美托洛尔，并排除了心脏手术和导管消融患者。低血压（定义为收缩压<90mmHg）作为次要结局进行测量。两名作者进行了全文文章审查和数据提取，第三名作者对分歧进行了调解。使用逆方差加权的随机效应模型计算比值比（OR）和 95%置信区间（CI）。使用 I 检验评估异质性。
通过系统搜索共确定了 563 个独特的标题，其中纳入了 16 项研究（7 项随机研究和 9 项观察性研究）。在按研究类型进行的 HR 控制的主要分析中，IV 地尔硫卓在随机试验中比 IV 美托洛尔更有效地控制 HR（OR 4.75，95%CI 2.50-9.04，I = 14%）；然而，对于观察性研究并未发现这种情况（OR 1.26，95%CI 0.89-1.80，I = 55%）。在对观察性研究的分析中，两种药物在低血压的发生几率方面没有显著差异（OR 1.12，95%CI 0.51-2.45，I = 18%）。
虽然与 IV 美托洛尔相比，IV 地尔硫卓在随机试验中更倾向于改善 HR 控制，但在观察性研究中并未发现这种情况，而且两种药物在低血压方面没有观察到差异。
