Management of atrial flutter and atrial fibrillation with rapid ventricular response in patients with acute decompensated heart failure: A systematic review

Abstract

Objective The objective was to evaluate the comparative effectiveness and safety of pharmacological and nonpharmacological management options for atrial fibrillation/atrial flutter with rapid ventricular response (AFRVR) in patients with acute decompensated heart failure (ADHF) in the acute care setting. Methods This study was a systematic review of observational studies or randomized clinical trials (RCT) of adult patients with AFRVR and concomitant ADHF in the emergency department (ED), intensive care unit, or step‐down unit. The primary effectiveness outcome was successful rate or rhythm control. Safety outcomes were adverse events, such as symptomatic hypotension and venous thromboembolism. Results A total of 6577 unique articles were identified. Five studies met inclusion criteria: one RCT in the inpatient setting and four retrospective studies, two in the ED and the other three in the inpatient setting. In the RCT of diltiazem versus placebo, 22 patients (100%) in the treatment group had a therapeutic response compared to 0/15 (0%) in the placebo group, with no significant safety differences between the two groups. For three of the observational studies, data were limited. One observation study showed no difference between metoprolol and diltiazem for successful rate control, but worsening heart failure symptoms occurred more frequently in those receiving diltiazem compared to metoprolol (19 patients [33%] vs. 10 patients [15%], p = 0.019). A single study included electrical cardioversion (one patient exposed with failure to convert to sinus rhythm) as nonpharmacological management. The overall risk of bias for included studies ranged from serious to critical. Missing data and heterogeneity of definitions for effectiveness and safety outcomes precluded the combination of results for quantitative meta‐analysis. Conclusions High‐level evidence to inform clinical decision making regarding effective and safe management of AFRVR in patients with ADHF in the acute care setting is lacking.

Association between atrial fibrillation/flutter and left ventricular failure: A bidirectional Mendelian randomization study

“…The issues of confounding and reverse causality highlighted in conventional studies cannot be disregarded. In summary, there is currently insu cient high-level evidence to inform clinical decision-making regarding the pharmacological and non-pharmacological management of AF/AFL in patients with HF [42].…”

Effects of Moracizine Combined with Metoprolol on Hemodynamic Indices of the Left Atrium and Quality of Life in Patients with Atrial Fibrillation

“…Trimetazidine can protect cardiomyocytes from injury and maintain the balance of myocardial blood supply and oxygen supply. Metoprolol can inhibit myocardial contraction to exert a hypotensive effect, inhibit endogenous catechol secretion, while also reducing myocardial oxygen consumption, heart rate, AF burden and the incidence of AF [20][21][22]. In AF patients with a high heart rate, the ventricle does not fully fill with blood and cardiac function decreases by approximately 25% due to the loss of atrial function, resulting in a smaller cardiac ejection volume and hemodynamic disorders [23].…”