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Background: Intravenous calcium channel blockers or beta-blockers are the preferred rate control medications for hemodynamically stable patients with atrial fibrillation with rapid ventricular rate (AFRVR) in the emergency department. Objectives: To compare the efficacy of intravenous diltiazem and metoprolol for rate control and safety with respect to development of hypotension and bradycardia in patients with AF-RVR. Methods: For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane databases, and the clinicaltrials.gov registry between database inception and 30th May 2021. Articles were included if they compared efficacy and safety of diltiazem versus metoprolol in critically ill adult patients hospitalized with AF-RVR. Outcome measures were achievement of rate control, development of new hypotension, and bradycardia after drug administration. Results: Of 86 records identified, 14 were eligible, all of which had a low to moderate risk of overall bias. The meta-analysis (Mantel-Haenszel, random-effects model) showed that diltiazem use was associated with increased achievement of rate control target compared to metoprolol [14 studies, n ¼ 1732, Odds Ratio (OR): 1.92; 95% Confidence Intervals (CI):1.26 to 2.90; I2 ¼ 61%]. In the pooled analysis, no differences were seen in hypotension using diltiazem vs metoprolol [12 studies, n ¼ 1477, OR: 0.96; 95% CI:0.61 to 1.52; I2 ¼ 35%] or bradycardia [9 studies, n ¼ 1203, OR: 2.44; 95% CI: 0.82 to 7.31; I2 ¼ 48%]. Conclusions: Intravenous diltiazem is associated with increased achievement of rate control target in patients with AF-RVR compared to metoprolol, while both medications are associated with similar incidence of hypotension and bradycardia.
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Background: The relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established, yet it is often missed. There is evidence of myocardial ischemia on stress imaging in AF patients in the absence of obstructive CAD. In this prospective cohort, we studied the angiographic profiles of non-valvular AF patients. Methods: The study was a nonrandomized, prospective, single-center observational study of consecutive patients of persistent non-valvular AF. Patients symptomatic for AF despite optimal medical therapy for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with prior history of CAD were excluded. Results: A total of 70 patients were followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49) years. Hypertension was the commonest comorbidity seen in 74% patients. Obstructive CAD was present in 32 (46%) patients, non-obstructive (<50% stenosis) CAD in 17 (24%) patients and normal coronaries in 21 (30%) patients. Overall 49 (70%) patients had evidence of CAD. Amongst patients without obstructive CAD, slow flow was seen in 16 (42%) patients. Lower baseline ejection fraction, lower haemoglobin & albumin levels and higher creatinine levels was associated with increased mortality. In patients without obstructive CAD, hospitalizations for fast ventricular rate were significantly increased in those having slow flow on CAG (p ¼ 0.005). Conclusions: Majority (70%) of our patients had evidence of atherosclerotic CAD on CAG. A large proportion of patients without obstructive CAD had slow flow on CAG.
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@#Objective To determine the effects of resecting the lower half of left stellate ganglion (LSG) on fast ventricular rate (VR) in persistent atrial fibrillation (AF) and its mechanism. Methods Twelve mature healthy male beagle dogs (15–25 kg) were studied. They were randomly divided into two groups (an experimental group and a control group, 6 dogs in each group). The control group were merely performed with rapid left atrial pacing to induce persistent AF. The experimental group were disposed with rapid left atrial pacing and received resection of the lower half of LSG after the persistent AF was documented. Simultaneously the ventricular rates were monitored separately before anesthesia, after anesthesia, 30 minutes and one month after LSG resection. The forward passing effective refractory period (ERP) of the canine atrioventricular node (AVN) was also measured. Results Each dog was documented with persistent AF after 3–6 weeks’ left atrial pacing. After resecting the lower half of LSG for 30 minutes (the control group was only observed for 30 minutes without LSG resection), the average VR of the control group attained 144.5±4.2 beats/min, while that of the experimental group was 121.5±8.7 beats/min (P<0.001). After resecting the lower half of LSG for one month (the control group was observed for one month without LSG resection), the average VR of the control group was 139.2±5.6 beats/min, while that of the experimental group was 106.5±4.9 beats/min (P<0.001). Meantime, the forward passing ERP of AVN of the experimental group was significantly prolonged than that of the control group (265.6±7.8 msvs.251.1±4.6 ms, P=0.003). Conclusion Resection of the lower half of LSG is efficient in reducing VR in canines with persistent AF, one of the mechanisms of which may be prolonging the forward passing ERP of AVN.
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Objective To investigate the clinical efficacy of amiodarone combined with succinylmetroprolol sustained-release tablets in patients with atrial fibrillation and congestive heart failure (CHF) complicated with atrial fibrillation (AF), and to observe the effect of amiodarone on heart function and ventricular rate.MethodsIn people's hospital of Anji county from June 2013 to June 2016 a total of 80 patients with atrial fibrillation and heart failure were enrolled in this study.The patients were randomly divided into control group and treatment group, 40 cases.(Ventricular rate, resting ventricular rate), cardiac function (ejection fraction-EF, stroke volume-SV, cardiac output-CO and left ventricular function) were measured before treatment and 6 months after treatment Ventricular end-diastolic early/late peak velocity ratio-VA/VE).The clinical efficacy and side effects during the treatment were statistically analyzed.ResultsThe ventricular rate and resting ventricular rate after exercise were significantly lower than those before treatment, but the ventricular rate and resting ventricular rate were significantly lower in the treatment group than those in the control group after 6 months of treatment (P<0.05).The VA/VE was significantly lower than that of the control group at 6 months after treatment, and the values of EF, SV and CO were significantly higher than those of the control group at 6 months after the treatment, SV, CO were significantly higher than the control group(P<0.05).Treatment group, the total effective rate was 92.5%, significantly higher than the control group 72.5%(χ2=7.77, P=0.02).No significant adverse reactions during treatment.ConclusionRapid ventricular rate of atrial fibrillation with congestive heart failure were treated with amiodarone combined with metoprolol succinate sustained release tablets can conducive to the ventricular rate and heart function of patients, and the effect is remarkable, safe, so it can be recommended as the drug of choice for clinical treatment of patients.
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The study was carried out to evaluate the effect of prophylactic single-dose intravenous amiodarone in patients undergoing valve replacement surgery. Maintenance of sinus rhythm is better than maintenance of fixed ventricular rate in atrial fibrillation (AF) especially in the presence of irritable left or right atrium because of enlargement. Fifty-six patients with valvular heart disease with or without AF were randomly divided into two groups. Group I or the amiodarone group (n=28) received amiodarone (3 mg/kg in 100 ml normal saline) and group II or the control group received same volume of normal saline. The standardized protocol for cardiopulmonary bypass was maintained for all the patients. AF occurred in 7.14% patients in group I, and in group II, 28.57% (P=0.035); ventricular tachycardia/fibrillation was observed in 21.43% patients in group I and 46.43% patients in group II (P=0.089) after release of aortic clamp. Most of the patients in group I (92.86%) maintained sinus rhythm without cardioversion or defibrillation after release of aortic cross clamp (P=0.002). Defibrillation or cardio version was needed in 7.14% patients in group I and 28.57% patients in group II (P=0.078). A single prophylactic intraoperative dose of intravenous amiodarone decreased post bypass arrhythmia in this study in comparison to the control group. Single dose of intraoperative amiodarone may be used to decrease postoperative arrhythmia in open heart surgery.
Subject(s)
Adult , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/physiopathology , Atrial Fibrillation/prevention & control , Cardiopulmonary Bypass , Electric Countershock , Female , Heart Valve Prosthesis Implantation/methods , Humans , Male , Middle Aged , Rheumatic Heart Disease/surgeryABSTRACT
Objective To discuss the significance of ventricular rate for patients with persistent a trial fibrillatio. Methods Patients with persistent atrial fibrillation more than 1 year were divided into cerebral embolism group (34 patients)and non- cerebral embolism group(32 patients). The data of patients in two groups were collected and compared ,including general clinical characteristics ,the highest ,lowest and average ventricular rate detected by Holter monitor system,left atria diameter and left ventricular ejecting fraction measured by echocardiography. Results There was no significant difference between two groups about general clinical characteristics, left atria diameter(P ＞ 0. 05).The highest, lowest and average ventricular rate were higher in cerebral embolism group than those in non-cerebral embolism group(P ＜ 0. 05). However, left ventricular ejecting fraction was much lower in cerebral embolism group( P ＜0. 05 ). Conclusion It is critical to control heart rate for patients with persistent atrial fibrillation to prevent cerebral embolism and left ventricular function.
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Objective To discuss the significance of ventricular rate for patients with persistent atrial fibrillation and to provide theoretical evidence for how to prevent patients of atrial fibrillation from complications such as cerebral embolism and left ventricular dysfunction, and so on. Methods Patients with persistent atrial fibrillation for more than 1 year were divided into cerebral embolism group and non-cerebral embolism group,30 patients per group. The data of patients in both groups were collected and compared, including general clinical characteristics, prothrombin time international standard ratio (PT-INR), the highest, lowest and average ventricular rate detected by Holter monitor system, left atria diameter and left ventricular ejecting fraction measured by echocardiography. Results There was no significant difference between two groups about general clinical characteristics, left atria diameter and PT-INR. The highest,lowest and average ventricular rate were much higher in patients of cerebral embolism group than those in non-cerebral embolism group. However, left ventricular ejecting fraction was much lower in embolism group. Conclusions It is critical to control heart rate for patients of persistent atrial fibrillation to prevent cerebral embolism and left ventricular dysfunction.