Efficacy And Safety Of Dronedarone Combined With Low-dose Metoprolol In Patients With Rapid Atrial Arrhythmia

Objective:This article mainly focuses on the efficacy and safety of dronedarone combined with low-dose metoprolol in the treatment of rapid atrial arrhythmia and provides reference for the later clinical combined drug treatment.Methods:Patients with rapid atrial arrhythmias(atrial premature beats,atrial tachycardia,paroxysmal atrial fibrillation(AF),and paroxysmal atrial flutter(AFL))who were treated in the out-patient or inpatient department of Northern People’s Hospital of Jiangsu Province from January 2020 to January 2022 were selected continuously.All study subjects were randomly divide into three groups:dronedarone group(D group),metoprolol group(M group)and dronedarone combined with metoprolol group(DM group).Collect general baseline data,blood pressure levels,relevant laboratory indicators,electrocardiogram parameters,48 hour dynamic electrocardiogram,echocardiography,and observe and record clinical symptoms.The number and duration of atrial premature beats,atrial tachycardia,AF,and AFL attacks,symptom changes,left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),and left ventricular ejection fraction(LVEF)and incidence of adverse events related to antiarrhythmic drugs(AADs)were compared before and after medication in three groups of patients,among which,male patients with CHA2DS2-VASc score of≥ 2 and female patients with a score of≥ 3 of non-valvular paroxysmal AF/AFL were given oral anticoagulants(rivaroxaban or warfarin).Patients who used warfarin need to regularly test the international normalized ratio(INR),and calculate the time in therapeutic range(TTR)of INR.The occurrence of thromboembolism and bleeding events during the medication period was counted.Results:1.Analysis of enrollment dataThis study plans to include 175 patients who meet the inclusion and exclusion criteria,including 62 patients in Group D,63 patients in Group M,and 50 patients in Group DM.During the follow-up process,a total of 9 cases were shed and 4 cases were not completed,with a dropout rate of 7.43%.There were 3 cases of detachment in Group D,5 cases in Group M,and 1 case in Group DM.There were 1 unfinished cases in Group D,2 unfinished cases in Group M,and 1 unfinished case in Group DM.162 patients were ultimately included in the study,including 58 in Group D,56 in Group M,and 48 in Group DM.2.Comparison of baseline data of three groups of patientsThe three groups of patients had sex,age,body mass index(BMI),smoking history,drinking history,and combined basic diseases,combined drugs,blood pressure level,N-terminal pro-B-type natriuretic peptide(NT-pro BNP),liver and renal function,thyroid function,resting heart rate,and corrected QT interval(QTc)were not statistically significant(P>0.05).3.Comparison of clinical efficacy of three groups of patients after medicationAfter 3 months of medication,the total effective rate of Group D was 60%,Group M was 54%,and Group DM was 79%,with statistically significant differences(P=0.007).After 6 months of medication,the total effective rate was 71%in Group D,59%in Group M,and 83%in Group DM,with statistically significant differences(P=0.0011).Comparing the clinical efficacy levels of the three groups of patients after 3 months,and 6 months of treatment,the DM group had an advantage in improving clinical efficacy and had statistical significance(P<0.05).3.1 Comparison of atrial premature beats,atrial tachycardia episodes and resting heart rate of three groups of patients after medicationAfter 3 months of medication,the number of atrial premature beats in the DM group decreased compared to before medication,and the difference was statistically significant(P<0.05).The resting heart rate of D group,M group,and DM group all decreased,with a statistically significant difference(P=0.033).Among them,the resting heart rate of M group decreased more significantly compared to D group(P<0.05).After 6 months of medication,there was a significant decrease(P=0.001)in the number of atrial premature beats in the D,M,and DM groups.Among them,the number of atrial premature beats in the DM group was significantly reduced compared to D group and M group(P<0.001),and the number of atrial premature beats in the DM group was significantly reduced compared to the medication for 3 months,with a statistically significant difference(P<0.05).The number of atrial tachycardia episodes in the DM group was significantly reduced compared to before and after 3 months of medication,with a statistically significant difference(P<0.05).The resting heart rate of group D,M,and DM decreased compared to before and after 3 months of medication,with a statistically significant difference(P<0.05).Among them,the resting heart rate of group M and DM decreased more significantly compared to group D(P<0.05).3.2 Comparison of the frequency and duration of atrial fibrillation and atrial flutter in three groups of patients after medicationAfter 6 months of medication,the number of AF episodes in the DM group was significantly reduced compared to before medication,with a statistically significant difference(P<0.05).After 3 months of medication,the duration of AF in group D was significantly shorter than that in group M,and the difference was statistically significant(P<0.05).After 6 months of medication,the duration of AF in the DM group was significantly shortened compared to before medication,with a statistically significant difference(P<0.05).Among them,the duration of AF in the DM group was more significantly shortened compared to the M group(P<0.05).After 6 months of medication for AFL patients,the number of AFL episodes in the DM group was significantly reduced compared to before medication,with a statistically significant difference(P<0.05).After 6 months of medication,the duration of AFL in group D and DM was significantly shortened compared to before medication,and the difference was statistically significant(P<0.05).4.Comparison of symptom efficacy among three groups of patients after medicationAfter 3 months of medication,the total effective rate in Group D was 64%,Group M was 61%,and Group DM was 79%,with statistically significant differences(P<0.001).After 6 months of medication,the total effective rate in Group D was 72%,Group M was 64%,and Group DM was 88%,with statistically significant differences(P<0.001).Comparing the symptom efficacy levels of the three groups of patients after 3 months and 6 months of treatment,the DM group had an advantage in improving symptom efficacy and had statistical significance(P<0.05).5.Comparison of cardiac function indexes and NT-pro BNP of three groups of patients before and after medicationThere were no significant differences in LAD,LVEDD,LVESD,LVEF,and NT pro BNP among the three groups of patients before medication,3 months after medication and 6 months after medication(P>0.05).6.Comparison of adverse events in three groups of patients after medication6.1 Incidence of adverse events related to AADs treatment in three groups of patientsAfter 3 months of medication,11 adverse events occurred in three groups of patients.After 6 months of medication,7 new adverse events occurred,the difference was not statistically significant(P>0.05).A total of 18 cases(11.25%)of AADs treatment related adverse events occurred,including 6 cases(10.5%)in Group D,8 cases(14.5%)in Group M,and 4 cases(8.3%)in Group DM.The incidence of adverse events was the lowest in the DM group,but there was no statistically significant difference in the total incidence of adverse reactions among the three groups(P=0.572).6.2 Occurrence of thromboembolism and bleeding events in patients with PAF/AFL after anticoagulation treatmentDuring the follow-up period,a total of 1 case(4.8%)of gastrointestinal bleeding occurred in patients receiving rivaroxaban without thromboembolism events.Among the patients treated with warfarin anticoagulation,the TTR of the three groups were 67.4±11.2%,64.0±9.4%and 65.5±10.5%respectively,with no statistically significant difference(P>0.05).During the follow-up period,there were 3 bleeding events in three groups,D group had 1 case(12.5%),M group had 1 case(16.7%),and DM group had 1 case(10%),with no statistically significant difference(P>0.05).There were 2 thromboembolic events,including 1 case in DM group(10%)and 1 case in M group(16.7%),with no significant difference(P>0.05).Conclusion:Dronedarone combined with low-dose metoprolol has a good clinical effect in the treatment of rapid atrial arrhythmia.It can not only significantly improve symptoms such as palpitations,chest tightness,fatigue,dizziness,but also significantly reduce the number of episodes of atrial premature beats and atrial tachycardia.It can also reduce the frequency and duration of AF and AFL,and effectively control heart rate.It does not significantly prolong the QTc interval and does not significantly increase adverse reactions of AADs,and has high clinical application value.