Meta Analysis In Efficacy And Safety Of TCM Treated For Paroxysmal Atrial Fibrillation Based On Grade Evaluation

Purposes:using meta analysis which is evidence-based medical literature evaluation means and an evidence-quality assessment of grande system to evaluate the clinical efficacy and safety of TCM on the treatment of paroxysmal atrial fibrillation in objective and comprehensive eyes.Methods:By searching Chinese journal full text database(CNKI),Chinese,Biome dical full text database(CBM),Chinese journal full text database(VIP),Wanfang database and other websites,as well as manually supplementary retrieval of clinical randomized controlled trials of TCM on the treatment of paroxysmal atrial fibrillati on.The retrieval time is from the establishment of the database to October 2019,for literature screening and data extraction,using Revman 5.3 System evaluation an d Gradepro system for evidence-quality classification.Results:A total of 27 articles were included,there are 2124 patients,1052 in the experimental group and 1012 in the control group.(1)Risk bias: the overall quality of the literature is low,there is a certain bias.(2)Meta analysis:(1)traditional Chinese medicine or combained with Western medicine are better than western medicine in improving the total clinical effect,TCM syndrome effect,ECG effect,P wave dispersion of ECG,TCM syndrome score,maximum P wave time limit,CRP level,left atrial diameter,atrial fibrillation frequency,palpitation,chest pain,insomnia,chest distress;(2)There is no advantage in improving the duration of AF,the average heart rate and the heart rate variability SDNN compared with western medicine,and there is no statistical significance;(3)there is no sufficient evidence to show that Chinese medicine or combained with western medicine has advantages in improving asthenia and vertigo,and further study isneeded to determine the efficacy.(3)Sensitivity analysis:(1)the overall clinical effect,TCM syndrome score,chest distress,vertigo,frequency of AF attack,duration of AF,ECG effect,average heart rate,SDNN,maximum P-wave time limit and other outcomes are stable and low sensitivity;(2)the outcome of asthenia syndrome is not stable and high sensitivity.(4)Publication bias:Those funnel plots show asymmetry include total clinical efficacy,TCM syndrome efficacy,TCM syndrome score,left atrial diameter,frequency of AF attack,duration of AF,P wave dispersion,maximum P wave time limit,and publication bias exists.(5)Grade outcome: there are many defects in the design of clinical randomized controlled trials of Chinese medicine in the intervention of paroxysmal atrial fibrillation.(6)Safety evaluation: 12 articles describe the adverse reactions of traditional Chinese medicine in the treatment of paroxysmal atrial fibrillation.The degree of adverse reactions of traditional Chinese medicine is lighter,and the incidence of adverse reactions is lower than that of Western medicine.Conclusion:(1)Chinese medicine treatment on paroxysmal atrial fibrillation could significantly improve the efficacy of Chinese medicine symptoms,ECG efficacy,ECG P wave dispersion and effectively improve the clinical efficacy,palpitation,chest pain,insomnia symptoms,TCM syndrome score,maximum P wave time limit,CRP level.(2)Traditional Chinese medicine has a certain effect on improving chest distress syndrome,left atrial diameter and frequency of atrial fibrillation,but the level of evidence is very low,which needs further study.(3)It is impossible to determine the advantages of traditional Chinese medicine in improving atrial fibrillation duration,mean heart rate,SDNN,asthenia and vertigo.(4)The safety of traditional Chinese medicine in treating PAF is promising.