To systematically review the effectiveness and safety of amiodarone combined with spirolactone versus amiodarone alone in the treatment of paroxysmal atrial fibrillation.

The databases of PubMed, Cochrane Library, WanFang Data, CNKI, and VIP were searched by computer to identify articles published up to October 2016 that reported randomized controlled trials (RCTs) on amiodarone combined with spirolactone versus amiodarone alone for treating paroxysmal atrial fibrillation. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of the included studies using the modified Jadad scale. Then meta-analysis was conducted using RevMan5.3 software.

Four RCTs involving 388 patients were included. The meta-analysis showed that compared with the single use of amiodarone (control group), the combination treatment (test team) was associated with comparable safety (OR = 0.66, 95% CI: 0.11-4.03, P = 0.65), significantly higher maintenance rate of sinus rhythm (OR = 0.38, 95% CI: 0.22-0.67, P = 0.0007), and significantly delayed enlargement of left atrial diameter (WMD =-1.72, 95% CI: -2.14--1.30, P<0.000 01).

The existing evidence suggests that amiodarone combined with spirolactone is better than amiodarone alone in the treatment of paroxysmal atrial fibrillation with regard to increasing the maintenance rate of sinus rhythm and significantly delaying the enlargement of left atrial diameter, although their safety is comparable.