European Heart Journal Advance Access published online on October 2, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl272
1 National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Level 5, Building F, 88 Mallett Street, Camperdown 2050, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia
* To whom correspondence should be addressed. Aims Atrial fibrillation (AF) is the most common complication after cardiac surgery. We aimed to evaluate, by meta-analysis, all randomized trials testing interventions for preventing AF. Methods and results Ninety-four trials of prevention of post-operative AF were identified, by standard search methods, and analysed by standard meta-analysis techniques. All five commonly tested interventions, beta-blockers (BBs), sotalol, amiodarone, magnesium, and atrial pacing, were effective in preventing AF. The odds ratio (OR) for the effect of BB on the incidence of AF was 0.36 (95% CI 0.28-0.47, P < 0.001), but after trials confounded by post-operative non-study BB withdrawal were excluded was 0.69 (95% CI 0.54-0.87, P = 0.002). Sotalol reduced AF, compared with placebo (OR 0.34, 95% CI 0.26-0.45, P < 0.001) and compared with conventional BB (OR 0.42, 95% CI 0.26-0.65, P < 0.001). Amiodarone reduced AF (OR 0.48, 95% CI 0.40-0.57, P < 0.001). Magnesium (Mg) also had an effect (OR 0.57 95% CI 0.42-0.77) but there was significant heterogeneity (P < 0.001), partly explained by concomitant BB. The effect of Mg with BB was less (OR 0.83, 95% CI 0.60-1.16). Pacing reduced AF (OR 0.60, 95% CI 0.47-0.77, P < 0.001), despite wide variations in techniques. Only amiodarone and pacing significantly reduced length of stay, average -0.60 days (95% CI -0.92 to -0.29) and -1.3 days (95% CI -2.55 to -0.08), respectively. Collectively, all treatments analysed together reduced stroke (OR 0.63, 95% CI 0.41-0.98). Amiodarone was the only intervention that alone significantly reduced stroke rate (OR 0.54, 95% CI 0.30-0.95). Conclusion All five interventions reduced the incidence of AF, though the effect of BBs is less than previously thought. The significant reductions in length of stay and stroke in meta-analysis suggest that there are worthwhile benefits from aggressive prevention. Larger studies to confirm these clinical benefits and evaluate their cost-effectiveness would be worthwhile.
Received February 6, 2006
Revised July 21, 2006
Accepted September 11, 2006
Clinical research
Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis
David C. Burgess 1 *, Michael J. Kilborn 2, and Anthony C. Keech 1 *
2 Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia
David C. Burgess, E-mail: startup{at}ctc.usyd.edu.au
Abstract 
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  O. J. Liakopoulos, Y.-H. Choi, E. W. Kuhn, T. Wittwer, M. Borys, N. Madershahian, G. Wassmer, and T. Wahlers Statins for prevention of atrial fibrillation after cardiac surgery: a systematic literature review. J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 678 - 686.e1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Price, R. Tee, B.-K. Lam, P. Hendry, M. S. Green, and F. D. Rubens Current use of prophylactic strategies for postoperative atrial fibrillation: a survey of Canadian cardiac surgeons. Ann. Thorac. Surg., July 1, 2009; 88(1): 106 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Crandall, D. J. Bradley, D. L. Packer, and S. J. Asirvatham Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies Mayo Clin. Proc., July 1, 2009; 84(7): 643 - 662. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. W Rho The management of atrial fibrillation after cardiac surgery Heart, March 1, 2009; 95(5): 422 - 429. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Kaireviciute, A. Aidietis, and G. Y.H. Lip Atrial fibrillation following cardiac surgery: clinical features and preventative strategies Eur. Heart J., February 2, 2009; 30(4): 410 - 425. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Echahidi, P. Pibarot, G. O'Hara, and P. Mathieu Mechanisms, Prevention, and Treatment of Atrial Fibrillation After Cardiac Surgery J. Am. Coll. Cardiol., February 26, 2008; 51(8): 793 - 801. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Lertsburapa, C. M. White, J. Kluger, O. Faheem, J. Hammond, and C. I. Coleman Preoperative statins for the prevention of atrial fibrillation after cardiothoracic surgery. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 405 - 411. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Mariscalco, R. Lorusso, C. Klersy, S. Ferrarese, M. Tozzi, D. Vanoli, B. V. Domenico, and A. Sala Observational Study on the Beneficial Effect of Preoperative Statins in Reducing Atrial Fibrillation After Coronary Surgery Ann. Thorac. Surg., October 1, 2007; 84(4): 1158 - 1164. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. E. Kettler, A. Parashar, M. I. Weintraub, A. Khoury, and M. Selim Perioperative Stroke N. Engl. J. Med., May 31, 2007; 356(22): 2325 - 2327. [Full Text] [PDF]
|
|
|
|
 |
|
 W. L Baker and C M. White Post-Cardiothoracic Surgery Atrial Fibrillation: A Review of Preventive Strategies Ann. Pharmacother., April 1, 2007; 41(4): 587 - 598. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. R. Kowey and G.-X. Yan The meta-analysis: supportive or illuminating? Eur. Heart J., December 1, 2006; 27(23): 2744 - 2745. [Full Text] [PDF]
|
|