The following is a summary of “Efficacy and safety of intravenous beta-blockers in acute atrial fibrillation and flutter is dependent on beta-1 selectivity: a systematic review and meta-analysis of randomised trials,” published in the September 2023 issue of Cardiology by Perrett et al.
Researchers performed a cohort study to evaluate the capability of intravenous beta-blockers in acute atrial fibrillation (AF) and atrial flutter (AFl) for beta-1 selectivity. They started a systematic review and meta-analysis of randomized trials (PROSPERO: CRD42020204772) to compare the safety and efficacy of intravenous beta-blockers against alternative pharmacological agents.
The results showed 12 trials, with 1,152 subjects, compared beta-blockers with diltiazem, digoxin, verapamil, anti-arrhythmic drugs, and placebo. Despite high heterogeneity (I2 = 87%; P< 0.001), there was no difference in heart rate reduction (standardized mean difference −0.65 beats/minute compared to control, 95% CI −1.63 to 0.32; P=0.19) or the proportion achieving the target heart rate ([RR] 0.85, 95% CI 0.36–1.97; P=0.70). Conventional selective beta-1 blockers were less effective for target heart rate reduction compared to control (RR 0.33, 0.17–0.64; P<0.001), while super-selective beta-1 blockers were superior (RR 1.98, 1.54–2.54; P<0.001). No significant differences between beta-blockers and comparators for secondary outcomes, including conversion to sinus rhythm (RR 1.15, 0.90–1.46; P=0.28), hypotension (RR 1.85, 0.87–3.93; P=0.11), bradycardia (RR 1.29, 0.25–6.82; P=0.76), or adverse events leading to drug discontinuation (RR 1.03, 0.49–2.17; P=0.93). Non-selective beta-blockers cause hypotension and bradycardia (P=0.031, P<0.001).
They concluded that beta-1 selective intravenous beta-blockers may improve efficacy and safety for acute heart rate control in atrial fibrillation and flutter.