Efficacy and safety of traditional Chinese medicine on thromboembolic events in patients with atrial fibrillation: A systematic review and meta-analysis

Effectiveness and safety of Liriope Tuber (Liriopis seu Ophiopogonis Tuber, Maidong) included traditional herbal medicine for patients with paroxysmal atrial fibrillation: A systematic review, meta-analysis, and network analysis

Background

Conventional medicine (CM) for paroxysmal atrial fibrillation (PAF) have limitations and side effects. Integrative approaches, including traditional herbal medicines like Liriope Tuber, are being explored for potential benefits, although evidence remains limited.

Methods

In April 2023, a literature search was conducted across nine databases, focusing on randomized controlled trials assessing the effects of Liriope Tuber in traditional herbal medicine (LTHM) on PAF. The risk of bias was evaluated using Version 2 of the Cochrane risk-of-bias tool for randomized trials. A random-effects model was employed for the meta-analysis.

Results

A total of 43 studies with 3,743 participants were included. The meta-analysis indicated that adding LTHM to CM reduced PAF frequency (SMD = -0.99, 95 % CI = -1.40 to -0.57, I² = 88 %, N = 16, n = 1266), left atrium diameter (LAD) (MD = -2.39 mm, 95 % CI = -3.09 to -1.68), P-wave dispersion (Pd) (MD = -6.41 ms, 95 % CI = -8.44 to -4.37), high sensitive C-Reactive Protein (hs-CRP) (MD = -1.10 mg/l, 95 % CI = -1.73 to -0.47), and improved left ventricular ejection fraction (LVEF) (MD = 4.71 %, 95 % CI = 3.17 to 6.25). Thirty-four studies raised concerns about bias, with eight showing high risk. Certainty of evidence was rated as "low" for PAF frequency, LAD, Pd, hs-CRP, and LVEF.

Conclusion

LTHM combined with CM may reduce PAF frequency. However, due to the complexity of interventions, with Liriope Tuber being only one component of the regimen, high risk of bias, substantial heterogeneity, and indirectness, interpretations should be cautious.

Study registration

PROSPERO (ID: CRD42023477926).

Advances in amelioration of plasma electrolytic oxidation coatings on biodegradable magnesium and alloys

Magnesium and its alloys are considered excellent materials for biodegradable implants because of their good biocompatibility and biodegradability as well as their mechanical properties. However, the rapid degradation rate severely limits their clinical applications. Plasma electrolytic oxidation (PEO), also known as micro-arc oxidation (MAO), is an effective surface modification technique. However, there are many pores and cracks on the coating surface under conventional PEO process. The corrosive products tend to penetrate deeply into the substrate, reducing its corrosion resistance and the biocompatibility, which makes PEO-coated Mg difficult to meet the long-term needs of in vivo implants. Hence, it is necessary to modify the PEO coating. This review discusses the formation mechanism and the influential parameters of PEO coatings on Mg. This is followed by a review of the latest research of the pretreatment and typical amelioration of PEO coating on biodegradable Mg alloys in the past 5 years, including calcium phosphate (Ca-P) coating, layered double hydroxide (LDH)-PEO coating, ZrO2 incorporated-PEO coating, antibacterial ingredients-PEO coating, drug-PEO coating, polymer-PEO composite coating, Plasma electrolytic fluorination (PEF) coating and self-healing coating. Meanwhile, the improvements of morphology, corrosion resistance, wear resistance, biocompatibility, antibacterial abilities, and drug loading abilities and the preparation methods of the modified PEO coatings are deeply discussed as well. Finally, the challenges and prospects of PEO coatings are discussed in detail for the purpose of promoting the clinical application of biodegradable Mg alloys.

Pharmacokinetics effects of chuanxiong rhizoma on warfarin in pseudo germ-free rats

Aim: In China, warfarin is usually prescribed with Chuanxiong Rhizoma for treating thromboembolism diseases. However, the reason for their combination is still being determined. The present study explored the pharmacokinetics interactions of warfarin, Chuanxiong Rhizoma, and gut microbiota in the rat model of middle cerebral artery occlusion (MCAO). Methods: A total of 48 rats were randomly divided into six groups: MCAO rats orally administered warfarin (W group), pseudo germ-free MCAO rats orally administered warfarin (W-f group), MCAO rats co-administered Chuanxiong Rhizoma and warfarin (C + W group), pseudo germ-free MCAO rats co-administered Chuanxiong Rhizoma and warfarin (C + W-f group), MCAO rats co-administered warfarin and senkyunolide I (S + W group); pseudo germ-free MCAO rats co-administered warfarin and senkyunolide I (S + W-f group). After treatment, all animals' blood and stool samples were collected at different time points. The stool samples were used for 16S rRNA sequencing analysis. Ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS) method was established to quantify warfarin, internal standards, and the main bioactive components of Chuanxiong in blood samples. The main pharmacokinetics parameters of warfarin were calculated by DAS 2.1.1 software. Results: The relative abundance of Allobaculum and Dubosiella in the pseudo germ-free groups (W-f, C + W-f, S + W-f) was lower than that in the other three groups (W, C + W, S + W). The relative abundance of Lactobacillus in the W-f group was higher than that of the W group, while the relative abundance of Akkermansia decreased. The relative abundance of Ruminococcaceae_UCG-014 and Ruminococcaceae_NK4A214_group in the S + W-f group was lower than in the S + W group. Compared to the W group, the AUC_0-t and C_max of warfarin in the W-f group increased significantly to 51.26% and 34.58%, respectively. The AUC_0-t and C_max in the C + W group promoted 71.20% and 65.75% more than the W group. Compared to the W group, the AUC_0-t and C_max increased to 64.98% and 64.39% in the S + W group. Conclusion: Chuanxiong Rhizoma and senkyunolide I (the most abundant metabolites of Chuanxiong Rhizoma aqueous extract) might affect the pharmacokinetics features of warfarin in MCAO rats through, at least partly, gut microbiota.

Network Pharmacology and Pharmacological Mechanism of CV-3 in Atrial Fibrillation

The high fatality and disability rate of atrial fibrillation (AF) strongly promote the development of pathogenesis and treatment of AF that is of great value. The present research attempted to clarify potential mechanisms of Mujiangzi oil (CV-3) in treating AF by constructing an AF cardiomyocytes model and using a network pharmacology approach. The experiment was divided into 4 groups: control, an AF model, AF + CV-3-treated, and the AF + verapamil group. Flow cytometry and the MTT assay were employed to detect cell apoptosis and cell viability, respectively. The main active components of CV-3 and predicted targets were obtained firstly, and molecular docking was performed. In the AF model, the cell apoptosis was aggravated, but inhibited in the CV-3-treated group. In addition, the cell viability was recovered after CV-3 treatment compared with the model group. Five potential active compounds of CV-3 were collected, including effective ingredients N-decanoic acid, spathulenol, copaene, β-panasinsene, and eucalyptol. Among them, N-decanoic acid and spathulenol was demonstrated to bind to PTGS2 with binding energy of −4.08 and −7.09 kcal/mol, respectively, and hydrogen bonds interaction were found. The present study indicated that CV-3 could alleviate AF cardiomyocytes apoptosis and improve cardiomyocytes viability, and N-decanoic acid and spathulenol may be the key components of CV-3 in treatment of AF by regulating PTGS2. This study provided the possible target PTGS2 and the understanding of molecular mechanisms of CV-3 in treating AF.

Comparison of the Efficacy and Safety of Non-vitamin K Antagonist Oral Anticoagulants with Warfarin in Atrial Fibrillation Patients with a History of Bleeding: A Systematic Review and Meta-Analysis

BACKGROUND

Patients with atrial fibrillation (AF) require oral anticoagulation to prevent ischemic stroke. However, oral anticoagulation may cause bleeding, and patients with AF and a history of bleeding were excluded from pivotal trials comparing non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin. We therefore aimed to assess the efficacy and safety of NOACs compared with warfarin in patients with AF and a history of bleeding.

METHODS

We conducted a systematic review of retrospective studies and clinical trials using the PubMed, EMBASE, SCOPUS, Cochrane Library, and Web of Science databases to May 2021.

RESULTS

Overall, 56,697 patients from six studies were included. NOACs significantly reduced the risk of ischemic stroke (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.59-0.91; p = 0.005), fatal ischemic stroke (HR 0.49, 95% CI 0.39-0.61; p < 0.001), all-cause mortality (HR 0.70, 95% CI 0.50-0.98; p = 0.04), major bleeding events (HR 0.75, 95% CI 0.67-0.84; p < 0.001), intracranial hemorrhage (ICH; HR 0.63, 95% CI 0.48-0.82; p < 0.001), fatal ICH (HR 0.33, 95% CI 0.20-0.56, p < 0.001), and gastrointestinal bleeding (HR 0.83, 95% CI 0.72-0.96; p = 0.01).

CONCLUSIONS

NOACs showed better efficacy and safety profile compared with warfarin in patients with AF and a history of bleeding. Randomized controlled trials are warranted to validate these findings.

Effect of Mahuang Fuzi and Shenzhuo Decoction on Idiopathic Membranous Nephropathy: A Multicenter, Nonrandomized, Single-Arm Clinical Trial

Objective: To explore the clinical effect of Mahuang Fuzi and Shenzhuo Decoction on idiopathic membranous nephropathy.

Methods: This study is a multicenter, nonrandomized, single-arm clinical trial carried out as per the objective performance criteria, with the target being set at 35.0%. 184 cases of patients suffering from idiopathic membranous nephropathy with Shaoyin Taiyin syndrome were collected. These patients were treated with Mahuang Fuzi and Shenzhuo Decoction with a follow-up period of 3 years. The 24-hour urine protein and blood albumin were observed, and the remission rates of the patients were compared with the target.

Results: The mean follow-up time was 18 (12.5, 30) months, and the remission rate was 61.4%, which is a statistically significant difference from the target group of 35%. The remission rates for patients who had and had not used immunosuppressive therapy were 59.6 and 65.5%, respectively, but the difference was not statistically significant (p = 0.254). However, the albumin before the treatment and the course of treatment of the patients was significantly correlated with the disease remission (p < 0.05). However, the albumin before the treatment and the course of treatment of the patients was significantly correlated with the disease remission (p < 0.05). There were no significant changes in renal function before and after treatment, and no severe adverse events occurred during treatment.

Conclusion: Mahuang Fuzi and Shenzhuo Decoction have significant effects on idiopathic membranous nephropathy, and has the same effect on patients with membranous nephropathy who are newly treated as well as those who have been treated with immunosuppressive therapy without remission. In addition, the efficacy of this regimen is related to the albumin and the duration of the therapy, but not to 24-hour urine protein or other factors.

Antithrombotic Therapy With Ticagrelor in Atrial Fibrillation Subjects After Percutaneous Coronary Intervention

Background: Warfarin, along with aspirin and clopidogrel, has long been recommended for patients with atrial fibrillation (AF) who are undergoing percutaneous coronary intervention with a drug-eluting stent (PCI-DES). However, this triple therapy has been known to increase the risk of bleeding complications. Meanwhile, there is no evidence from prospective trials on the use of ticagrelor in a dual therapy. We here aimed to compare the antiplatelet drug ticagrelor as a dual antithrombotic agent to aspirin and clopidogrel in bleeding events.

Methods: In this multicenter, active-controlled, open-label, randomized trial, patients with AF taking warfarin who had undergone PCI-DES were randomly assigned to the ticagrelor therapy group (Dual group) or the clopidogrel plus aspirin therapy group (Triple group). The primary and secondary endpoints were overall bleeding events and major bleeding events, respectively, according to the Thrombolysis in Myocardial Infarction (TIMI) criteria at 6 months. Cardiovascular events [re-PCI, surgical bypass, myocardial infarction (MI), heart failure, rehospitalization due to angina pectoris, stent thrombosis and death due to cardiovascular causes] at 6 months were also recorded.

Results: A total of 296 patients from 12 medical centers in China were randomized after PCI-DES to either the Dual therapy group (n = 148) or the Triple group (n = 146) for 6 months. The overall incidence of bleeding events at 6 months was 36.49% in the Dual therapy group and 35.62% in the Triple group [hazard ratio, 0.930; 95% confidence interval (CI), 0.635 to 1.361; P = 0.7088]. The incidence of the secondary endpoint over 6 months was 4.73% in the Dual therapy group and 1.37% in the Triple group (hazard ratio, 0.273; 95% CI, 0.057 to 1.315; P = 0.1056). Cardiovascular event occurrence was also comparable in both groups at 6 months (18.24 vs. 16.44%; hazard ratio, 0.845; 95% CI, 0.488 to 1.465; P = 0.5484).

Conclusions: The incidence of total bleeding events in AF patients treated with ticagrelor was comparable to that in patients treated with clopidogrel plus aspirin at 6 month; Meanwhile, the incidence of cardiovascular events were also comparable between the groups.

Clinical Trial Registration: MANJUSRI, ClinicalTrials.gov# NCT02206815, 2014, August 1^st

Molecular Targets and Pathways Contributing to the Effects of Wenxin Keli on Atrial Fibrillation Based on a Network Pharmacology Approach

BACKGROUND

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with high rates of mortality and morbidity. The traditional Chinese medicine Wenxin Keli (WXKL) can effectively improve clinical symptoms and is safe for the treatment of AF. However, the active substances in WXKL and the molecular mechanisms underlying its effects on AF remain unclear. In this study, the bioactive compounds in WXKL, as well as their molecular targets and associated pathways, were evaluated by systems pharmacology.

MATERIALS AND METHODS

Chemical constituents and potential targets of WXKL were obtained via the Traditional Chinese Medicine Systems Pharmacology (TCMSP). The TTD, DrugBank, DisGeNET, and GeneCards databases were used to collect AF-related target genes. Based on common targets related to both AF and WXKL, a protein interaction network was generated using the STRING database. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGGs) pathway enrichment analyses were performed. Network diagrams of the active component-target and protein-protein interactions (PPIs) were constructed using Cytoscape.

RESULTS

A total of 30 active ingredients in WXKL and 219 putative target genes were screened, including 83 genes identified as therapeutic targets in AF; these overlapping genes were considered candidate targets for subsequent analyses. The effect of treating AF was mainly correlated with the regulation of target proteins, such as IL-6, TNF, AKT1, VEGFA, CXCL8, TP53, CCL2, MMP9, CASP3, and NOS3. GO and KEGG analyses revealed that these targets are associated with the inflammatory response, oxidative stress reaction, immune regulation, cardiac energy metabolism, serotonergic synapse, and other pathways.

CONCLUSIONS

This study demonstrated the multicomponent, multitarget, and multichannel characteristics of WXKL, providing a basis for further studies of the mechanism underlying the beneficial effects of WXKL in AF.

Efficacy and safety of ShenSongYangXin Capsule combined with antiarrhythmic drugs for atrial fibrillation: A protocol for systematic review and network meta-analysis

BACKGROUND

Shen-Song-Yang-Xin Capsule (SSYX), a Chinese patent medicine, combined with antiarrhythmic drugs (AADs) in the treatment of atrial fibrillation (AF) has been widely applied in clinical practice, but the results are controversial. This study aims to conduct a network meta-analysis (NMA) based on data from the randomized controlled trials (RCTs) to evaluate the efficacy and safety of SSYX combined with ADDs in the treatment of AF.

METHODS AND ANALYSIS

A comprehensive systematic literature search will be conducted in Cochrane Library, PubMed, Web of Science, EMBASE, Chinese Biomedical Literature Database (SinoMed), Chinese National Knowledge Infrastructure (CNKI), and WanFang database for RCTs about SSYX combined with ADDs. The primary outcomes will be the frequency of AF attack and P-wave dispersion, and the secondary outcomes will be the symptom improvements, left atrial diameter, and adverse events. Statistical analyses will be conducted by using WinBUGS software (version 1.4.3), Stata software (version 14.0) and RevMan software (version 5.3).

RESULTS

The results of this NMA will provide a high-quality evidence for the efficacy of SSYX combined with ADDs in the treatment of AF, and a ranking of the therapeutic classes will also be presented.

CONCLUSION

The protocol will provide updated evidence for the application of SSYX for AF. INTERNATIONAL PLATFORM OF REGISTERED SYSTEMATIC REVIEW AND META-ANALYSIS PROTOCOLS (INPLASY) REGISTRATION NUMBER:: The protocol of this systematic review and meta-analysis was registered on the INPLASY website (https://inplasy.com/inplasy-2020-8-0075/) and INPLASY registration number is INPLASY202080075.

Obstructive sleep apnea hypopnea syndrome: Protocol for the development of a core outcome set

BACKGROUND

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common, chronic sleep disease. As the incidence of OSAHS increases, it has seriously threatened people's health. There have been an increasing number of clinical trials of OSAHS in recent years. However, the clinical trials of OSAHS have heterogeneous outcomes, surrogate outcomes, subjective outcomes, and composite outcomes, as well as the lack of endpoints or patient perspectives. The best method is to develop a core outcomes sets (COSs) for OSAHS's clinical trials.

METHODS

The development of COSs of OSAHS will include 5 stages: RESULTS:: The results of our study will be published in a peer-reviewed journal.

DISCUSSION

The development of the COSs of OSAHS will improve the design and operation of OSAHS clinical trials to conform to international standards and ensure the credibility of the outcomes. In addition, this study will involve different stakeholder groups to help ensure that the developed COSs will be suitable and well accepted.

TRIAL REGISTRATION NUMBER

1544.

Reduced Stroke Risk among Patients with Atrial Fibrillation Receiving Chinese Herbal Medicines Treatment: Analysis of Domestic Data in Taiwan

Background and objectives: Patients with atrial fibrillation (AF) reportedly have a much higher risk of death due to stroke. Faced with this heavy burden, it remains unclear if the Chinese herbal medicines (CHMs), the most common form complementary and alternative medicine, can lower the risk of stroke for them. This study aimed to evaluate the association of CHMs use with stroke risk among them. Materials and Methods: From a nationwide database, 11,456 AF patients aged ≧ 20 years between 1998 and 2007 were identified. Afterwards, we enrolled 2670 CHMs users and randomly selected 2670 non-CHMs users using the propensity score method. The occurrence of stroke was recorded until the end of 2012. Results: Within the follow-up period, 671 CHMs users and 900 non-CHMs users developed stroke, with incidence rates of 33.02 and 45.46 per 1000 person-years, respectively. CHMs use was associated with a 30% lower stroke risk, especially for those receiving CHMs for over two years. Conclusions: The findings of the present study suggest that adding CHMs to conventional therapy could decrease subsequent stroke risk for AF patients. It is also suggested that prospective randomized trials are needed to further clarify if the detected association revealed in this study supports a causal link, and to identify the specific CHMs that may be beneficial to AF patients.

Rethinking potentially inappropriate medication use in nursing homes within the Chinese population

This study aimed to understand the prevalence of Chinese medicine and other potentially inappropriate medications and to examine if there are relationships with emergency room visits, hospital admissions, and falls in a Chinese nursing home population. This cross-sectional descriptive study was a secondary analysis of data from 531 nursing home residents in Taiwan. Cox proportional hazard regression models were used in the analysis. Use of Chinese medicine in combination with Western medicine was observed in approximately 1% of residents. For every additional Chinese medicine used, the hazard ratio was 3.09 (p=.26) for emergency room visits and 3.22 (p=.21) for hospital admissions. For every additional nonsteroidal antiinflammatory agent used, the hazard ratio for falls was 5.42 (p=.006). Further studies with larger sample sizes are required to understand the appropriate time intervals required between administration of Chinese and Western medicine as well as to understand the drug-drug interactions.

Development of a core outcome set (COS) and selecting outcome measurement instruments (OMIs) for non-valvular atrial fibrillation in traditional Chinese medicine clinical trials: study protocol

BACKGROUND

An increasing number of clinical trials of traditional Chinese medicine are being conducted in the treatment of non-valvular atrial fibrillation (NVAF) in China. However, the heterogeneity of outcomes and outcome measurement instruments has produced little evidence for traditional Chinese medicine in treating NVAF because many trials cannot be included in a meta-analysis. The majority of the trials did not report endpoint outcomes, side effects or other important outcomes for patients, which makes it difficult to evaluate the efficacy and safety of traditional Chinese medicine. Therefore, it is important to develop a core outcome set (COS). Although there are two related COSs for clinical trials of atrial fibrillation, the methodology is limited, and the perspectives of Chinese experts and patients are unclear. Therefore, we will develop a COS and recommend outcome measurement instruments after finishing the COS, which can be used for clinical trials of traditional Chinese medicine in NVAF.

METHODS/DESIGN

The method of the study will include eight stages led by a national multidisciplinary Steering Committee: (1) A systematic review will be developed to identify currently reported outcomes and traditional Chinese medicine syndromes in clinical trials of NVAF, (2) Semi-structured interviews of patients will be conducted to fill gaps in potential outcomes, (3) Traditional Chinese medicine syndrome names will be identified from medical records, (4) A dataset of traditional Chinese medicine syndrome names will be developed, (5) The investigation of traditional Chinese medicine syndromes will be conducted from cross-sectional study, (6) Two rounds of Delphi surveys will be carried out, (7) A consensus meeting will be conducted to develop a COS, and (8) Recommendations of outcome measurement instruments (OMIs), which should be used in the COS, will be developed.

DISCUSSION

The COS will improve the consistency of outcome reporting and reduce the reporting bias in NVAF clinical trials of traditional Chinese medicine to improve the value of traditional Chinese medicine clinical trials.

TRIAL REGISTRATION

This study is not a clinical trial, so it is registered in Core Outcome Measures in Effectiveness Trials Initiative (COMET). Registration number: 941 . Registered on 22 December 2016.

Chinese Herbal Medicine as a Potential Treatment of Abdominal Aortic Aneurysm

Abdominal aortic aneurysm (AAA) is an irreversible condition where the abdominal aorta is dilated leading to potentially fatal consequence of aortic rupture. Multiple mechanisms are involved in the development and progression of AAA, including chronic inflammation, oxidative stress, vascular smooth muscle (VSMC) apoptosis, immune cell infiltration and extracellular matrix (ECM) degradation. Currently surgical therapies, including minimally invasive endovascular aneurysm repair (EVAR), are the only viable interventions for AAAs. However, these treatments are not appropriate for the majority of AAAs, which measure <50 mm. Substantial effort has been invested to identify and develop pharmaceutical treatments such as statins and doxycycline for this potentially lethal condition but these interventions failed to offer a cure or to retard the progression of AAA. Chinese herbal medicine (CHM) has been used for the management of cardiovascular diseases for thousands of years in China and other Asian countries. The unique multi-component and multi-target property of CHMs makes it a potentially ideal therapy for multifactorial diseases such as AAA. In this review, we review the current scientific evidence to support the use of CHMs for the treatment of AAA. Mechanisms of action underlying the effects of CHMs on AAA are also discussed.

Wenxin Keli for atrial fibrillation: Protocol for a systematic review and meta-analysis

BACKGROUND

Atrial fibrillation (AF) is a most common cardiac arrhythmia in clinical practice. In China, Wenxin Keli (WXKL) therapy is a common treatment for AF, but its effects and safety remain uncertain. This protocol is to provide the methods used to assess the effectiveness and safety of WXKL for the treatment of patients with AF.

METHODS

We will search comprehensively the 4 English databases EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, and Medline and 3 Chinese databases China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Chinese Science and Technology Periodical database (VIP) on computer on March 2018 for the randomized controlled trials (RCTs) regarding WXKL for AF. The therapeutic effects according to the sinus rhythm and p-wave dispersion (Pwd) will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed.

RESULTS

This study will provide a high-quality synthesis of current evidence of WXKL for AF.

CONCLUSION

The conclusion of our systematic review will provide evidence to judge whether WXKL is an effective intervention for patient with AF.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD 42018082045.

Chinese herbal medicine for patients with atrial fibrillation: protocol for a systematic review and meta-analysis

BACKGROUND

Atrial fibrillation (AF) is the most clinically common cardiac arrhythmia. Chinese herbal medicine (CHM) has been widely applied in the treatment of AF, However, to our knowledge, there has been no systematic review and meta-analysis of randomized controlled trails (RCTs) regarding the effectiveness of this treatment. Therefore, we provide a protocol to evaluate the effectiveness and safety of CHM for AF.

METHODS

The databases reviewed to collect RCTs related to CHM treatment for AF will be as follows: 3 English literature databases, which are PubMed, Embase, and Cochrane Library, and 3 Chinese literature databases, which are CBM, CNKI, and Wanfang. The data collection in the above-mentioned databases will be from the time when the respective databases were established to December 2017. The maintenance of sinus rhythm and p-wave dispersion will be accepted as the primary outcomes. Quality of life (QOL), such as QOL scale embolic events, bleeding events, and symptom improvement (such as chest distress, palpitations, etc) will be measured as secondary outcomes. Two reviewers will independently screen the titles, abstracts, or even full texts, and extract data. Methodological quality will be evaluated according to the Cochrane risk of bias. All analyses will be applied by RevMan (version 5.3).

RESULTS

The results of study will be disseminated via both international conference and peer-review journal.

CONCLUSION

The conclusion of our systematic review will provide evidence to judge whether CHM is an effective intervention for patient with AF.