普罗帕酮治疗心房颤动的Meta分析

A Meta-Analysis for the Treatment of Atrial Fibrillation With Propafenone.

应用Meta分析评价普罗帕酮转复心房颤动 (简称房颤 )和 (或 )心房扑动及药物、电转复后抑制房颤复发的疗效。应用检索公开发表的相关的英、中文文献建立数据库 ,应用Meta统计分析方法按观察时间、给药途径对数据进行综合分析。结果 :普罗帕酮转复阵发性房颤的疗效随时间延长而增加 ,静脉转复率 1h为 3 7.0 %( 95 %可信区间3 2 .9%～ 4 1.2 %)、8h为 61.4 %( 4 8.2 %～ 74 .5 %) ;口服普罗帕酮转复房颤疗效在 2 ,4 ,8h分别达到 4 .0 %( 3 .8%～4 .2 %)、4 7.3 %( 4 3 .8%～ 5 0 .8%)、72 .6%( 62 .8%～ 82 .4 %) ,2 4h为 81.4 %( 5 2 .0 %～ 10 0 %)、4 8h为 76.5 %( 5 4 .1%～ 98.8%)。前 4h静脉用药比口服起效迅速。口服普罗帕酮与安慰剂对比 ,转复房颤的差异在用药后 8h最显著[3 7.7%( 2 9.4 %～ 4 5 .9%) ,P <0 .0 0 1],在 2 4h两者之差减少为 17.3 %( - 5 .0 %～ 3 9.7%) (P =0 .13 )。药物或直流电转复后普罗帕酮长期应用预防复发、维持窦性的疗效 ,在给药后 1个月的病人中为 63 .80 %( 5 8.2 %～ 69.4 %) ,6个月后为 5 4 .70 %( 4 8.0 %～ 61.4 %)。结论 :普罗帕酮能安全有效转复房颤 ,长期应用可预防转复后复发 ,耐受性好。

The purpose of this study was to determine in propafenone′s effectiveness in terminating and suppressing atrial fibrillation (AF) or atrial flutter using meta-analytic techniques.Methods:Published English and Chinese abstracts and manuscripts with these goals were selected and data were abstracted on conversion and maintenance of sinus rhythm.Data were pooled using standard meta-analytic techniques and analyzed according to observation times and route of drug administration.Results:Propafenone with intravenous medications successfully terminated 37.0%(95% confidence intervals 32.9%～41.2%)of AF 1 hour and 61.4%(48.2%～74.%) 8 hours after initiation of therapy.The likelihood of converting a paroxysm of AF with oral therapy increased over time,with 4.0%(3.8%～4.2%),47.3%(43.8%～50.8%),72.6%(62.8%～82.4%) of patients in sinus rhythm 2,4 and 8 hours after initiation of therapy.Further increments in conversion to sinus rhythm occurred over time as follows:24 hours 81.4%(52.0%～100%) and 48 hours 76.5%(54.1%～98.8%).Patients receiving intravenous therapy were more likely to convert to sinus rhythm in the first 4 hours after drug administration.The treatment benefit of propafenone versus placebo in converting sinus rhythm was greatest in the first 8 hours after treatment [treatment benefit of 37.7%(29.4%～45.9%),P<0.001].This treatment benefit decreased to 17.3%(-5.0%～39.7%)(P=0.13) after 24 hours.Propafenone was effective in suppressing recurrence of AF after drug or direct current cardioversion in 63.80%(58.2%～69.4%) at 1 months and 54.70%(48.0%～61.4%) at 6 months.Conclusion:Propafenone is safe and effective in terminating AF in the vast majority of patients.Suppression of arrhythmia recurrences is feasible and well tolerated in most patients after cardioversion.