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Abstract：
This study aims to assess the association between intravenous diltiazem and metoprolol in rate control for atrial fibrillation (AF) patients with rapid ventricular rate, focusing on rate control efficacy and hemodynamic adverse events. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, electronic searches were conducted in Embase, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) until February 20, 2024. The primary outcome was achieving ventricular rate control < 110/min. Secondary outcomes included new hypotension (systolic blood pressure < 90 mm Hg) and bradycardia (heart rate < 60/min). Nineteen studies (three randomized controlled trials and 16 observational studies) were included in this meta-analysis. Pooled analysis showed intravenous metoprolol resulted in a 39% lower rate control attainment compared to diltiazem (OR: 0.61; 95% CI: 0.44 to 0.84; p = 0.002). There were no significant differences in bradycardia (OR: 0.51; 95% CI: 0.22 to 1.22; p = 0.13) or hypotension risk (OR: 1.08; 95% CI: 0.72 to 1.61; p = 0.72) between the two groups. Intravenous diltiazem demonstrated superior rate control efficacy compared to metoprolol in AF patients with rapid ventricular rate. However, no significant differences were observed in safety outcomes, namely, bradycardia and hypotension.
摘要：
本研究旨在评估静脉注射地尔硫卓和美托洛尔在快速心室率房颤（AF）患者的心率控制中的相关性。重点关注心率控制疗效和血流动力学不良事件。遵循系统审查和荟萃分析(PRISMA)指南的首选报告项目，在Embase进行了电子搜索，PubMed,和Cochrane中央控制试验登记册（中央），直到2024年2月20日。主要结果是实现心室率控制<110/min。次要结果包括新的低血压（收缩压<90mmHg）和心动过缓（心率<60/min）。该荟萃分析包括19项研究（3项随机对照试验和16项观察性研究）。汇总分析显示，与地尔硫卓相比，静脉注射美托洛尔的心率控制率降低了39％（OR：0.61；95％CI：0.44至0.84；p=0.002）。两组之间的心动过缓（OR：0.51；95％CI：0.22至1.22；p=0.13）或低血压风险（OR：1.08；95％CI：0.72至1.61；p=0.72）没有显着差异。在快速心室率的房颤患者中，静脉地尔硫与美托洛尔相比具有更好的心率控制功效。然而,在安全性结果方面没有观察到显著差异,即,心动过缓和低血压。
