Comparison Of The Efficacy And Safety Of Intravenous Diltiazem And Metoprolol In Controlling The Rapid Ventricular Rate In Patients With Atrial Fibrillation: A Meta-analysis

Objective: To compare the efficacy and safety of intravenous diltiazem and metoprolol for the control of rapid ventricular rate in patients with atrial fibrillation.This study is a secondary research aiming to conduct a meta-analysis that compare efficacy and safety of intravenous diltiazem and metoprolol in controlling rapid ventricular rate of atrial fibrillation,and provide a certain basis for rapid ventricular rate controlling in clinical.Methods: The databases of Pub Med、EMbase、Cochrane Library、Web of Science、CNKI、VIP、CBM and Wanfang were retrieved with computer from their establishment to Oct.2015 for collecting randomized controlled trials(RCTs)about comparison in curative effect and safety of diltiazem and metoprolol in treatment of atrial fibrillation with rapid ventricular rate.The data was screened and extracted by two independent reviewers according to inclusion and exclusion criterions.The bias risk assessment method,which was provided by the Cochrane5.1 Handbook,was used to evaluate the quality of the included studies,and then a Meta-analysis was conducted by using Rev Man 5.3 software.Results: There were totally 6 RCTs included involving 366 patients.The results of Meta-analysis showed that:(1)efficacy indicators: there was no significant difference between diltiazem and metoprolol for the control of rapid ventricular rate in atrial fibrillation of total effective rate(RR=1.12,95%CI:0.96~1.31,P=0.14>0.05)and mean onset time(MD=-0.50,95%CI :-1.68~0.67,P=0.40 > 0.05),while ventricular rate decreased amplitude of diltiazem group was more than metoprolol group(MD=10.01,95%CI:3.95~16.07,P=0.001<0.05).(2)safety indicators: both of the adverse reactions(including systolic blood pressure < 90 mm Hg,heart rate < 60bpm)incidence rate showed no significant difference(RD=-0.00,95%CI:-0.04~0.04,P=0.89>0.05).Conclusion: The existing evidences show that diltiazem has no differece in total effective rate,mean onset time and safety compared with metoprolol in treatment of atrial fibrillation with rapid ventricular rate,but it has a greater ventricular rate decreased amplitude.This study is limited by the quantity and quality of included literature,and it is necessary to carry out more strictly-designed,large-sample and multi-center RCTs to confirm this result.