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European Heart Journal Advance Access originally published online on February 8, 2007
European Heart Journal 2007 28(4):457-462; doi:10.1093/eurheartj/ehl484
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Prevention of atrial fibrillation onset by beta-blocker treatment in heart failure: a meta-analysis

Imad Abi Nasr1,*, Anissa Bouzamondo1, Jean-Sébastien Hulot1, Olivier Dubourg3, Jean-Yves Le Heuzey2 and Philippe Lechat1

1 Clinical Pharmacology Department, La Pitié Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, 47 Boulevard de l’Hôpital, 75013 Paris, France
2 Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
3 Cardiology Department, Hôpital Universitaire Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France

Received 2 May 2006; revised 22 November 2006; accepted 4 January 2007; online publish-ahead-of-print 8 February 2007.

* Corresponding author. Tel: +331 49095626; fax: +331 49095344. E-mail address: imad.abi-nasr{at}apr.aphp.fr

AIMS: Atrial fibrillation (AF) is an important morbidity–mortality risk factor, especially in patients with heart failure (HF). Beta-blockers reduce morbidity and mortality in HF. The study was designed to estimate the preventive efficacy of beta-blocker treatment on AF occurrence in patients with HF.

METHODS AND RESULTS: A systematic review of the literature was performed to identify all clinical trials evaluating beta-blockers' efficacy in HF. Eligible studies had to be randomized, placebo-controlled and providing information on the incidence of AF during follow-up among those with sinus rhythm at baseline. A total of seven studies which included 11 952 patients receiving a background treatment with angiotensin-converting enzyme-inhibitors could be found. Overall, beta-blockers significantly reduced incidence of onset of AF from 39 to 28 per 1000 patient-years: relative risk reduction = 27% (95% confidence interval 14–38, P < 0.001); heterogeneity test: P = 0.096. A same trend of efficacy was observed in all trials except the SENIORS study. In this trial which included aged patients (>70 years) with systolic or diastolic HF, a higher prevalence of AF at baseline (35%) was observed compared with the mean baseline prevalence (13%).

CONCLUSION: Beta-blockers appear to effectively prevent occurrence of AF in patients with systolic HF.

Key Words: Beta-blocker • Atrial fibrillation • Heart failure • Primary prevention • Meta-analysis


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