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With high heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200987%; p\u2009&lt;\u20090.001), there was no difference in the primary outcomes of heart rate reduction (standardised mean difference \u2212\u00a00.65 beats\/minute compared to control, 95% CI \u2212\u00a01.63 to 0.32; p\u2009=\u20090.19) or the proportion that achieved target heart rate (risk ratio [RR] 0.85, 95% CI 0.36\u20131.97; p\u2009=\u20090.70). Conventional selective beta-1 blockers were inferior for target heart rate reduction versus control (RR 0.33, 0.17\u20130.64; p\u2009&lt;\u20090.001), whereas super-selective beta-1 blockers were superior (RR 1.98, 1.54\u20132.54; p\u2009&lt;\u20090.001). There was no significant difference between beta-blockers and comparators for secondary outcomes of conversion to sinus rhythm (RR 1.15, 0.90\u20131.46; p\u2009=\u20090.28), hypotension (RR 1.85, 0.87\u20133.93; p\u2009=\u20090.11), bradycardia (RR 1.29, 0.25\u20136.82; p\u2009=\u20090.76) or adverse events leading to drug discontinuation (RR 1.03, 0.49\u20132.17; p\u2009=\u20090.93). The incidence of hypotension and bradycardia were greater with non-selective beta-blockers (p\u2009=\u20090.031 and p\u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Across all intravenous beta-blockers, there was no difference with other medications for acute heart rate control in atrial fibrillation and flutter. Efficacy and safety may be improved by choosing beta-blockers with higher beta-1 selectivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-023-02295-0","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T13:01:47Z","timestamp":1693573307000},"page":"831-841","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["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"],"prefix":"10.1007","volume":"113","author":[{"given":"Madeleine","family":"Perrett","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha","family":"Gohil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otilia","family":"Tica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina V.","family":"Bunting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2570-9812","authenticated-orcid":false,"given":"Dipak","family":"Kotecha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,9,1]]},"reference":[{"key":"2295_CR1","doi-asserted-by":"publisher","first-page":"e005155","DOI":"10.1161\/JAHA.116.005155","volume":"6","author":"DA Lane","year":"2017","unstructured":"Lane DA, Skjoth F, Lip GYH, Larsen TB, Kotecha D (2017) Temporal trends in incidence, prevalence, and mortality of atrial fibrillation in primary care. 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OT is funded through grants from the EU\/EEPIA Innovative Medicines Initiative (BigData@Heart 116074) and Amomed Pharma. KB was the Research fellow for the RATE-AF trial funded by the NIHR (NIHR CDF-2015-08-074) and has been awarded a grant from the University of Birmingham\u2019s British Heart Foundation Accelerator Award (BHF AA\/18\/2\/34218). DK reports grants from the National Institute for Health Research (NIHR CDF-2015-08-074 RATE-AF; NIHR130280 DaRe2THINK; NIHR132974 D2T-NeuroVascular; NIHR203326 Biomedical Research Centre), the British Heart Foundation (PG\/17\/55\/33087, AA\/18\/2\/34218 and FS\/CDRF\/21\/21032), the EU\/EFPIA Innovative Medicines Initiative (BigData@Heart 116074), EU Horizon\/UKRI (HYPERMARKER 101095480), UK National Health Service -Data for R&D- Subnational Secure Data Environment programme, UK Dept. for Business, Energy & Industrial Strategy Regulators Pioneer Fund, the Cook & Wolstenholme Charitable Trust, and the European Society of Cardiology supported by educational grants from Boehringer Ingelheim\/BMS-Pfizer Alliance\/Bayer\/Daiichi Sankyo\/Boston Scientific, the NIHR\/University of Oxford Biomedical Research Centre and British Heart Foundation\/University of Birmingham Accelerator Award (STEEER-AF). In addition, he has received advisory board fees from Bayer, Amomed and Protherics Medicines Development, all outside the submitted work, and his institution has received research grants from these organisations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}