Interventions for prevention of postoperative AF and its complications after cardiac surgery: a meta-analysis
ABSTRACT 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.
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).
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.
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ABSTRACT: Background : Atrial fibrillation (AF) is the most common arrhythmia to occur after cardiac surgery. The incidence of post-operative atrial fibrillation (POAF) has been reported to range from 10 to 65%. It is associated with increased morbidity, mortality, longer hospital stay and increased costs. A number of studies have examined the predictors of POAF. There have never been any studies evaluating the correlation between pre-operative pulmonary artery pressure (PAP) and the incidence of POAF. Objective : This study aims to prospectively assess pre-operative mean PAP as a predictor of POAF. Methods : One hundred and nine consecutive elective cardiac surgery patients were enrolled. Baseline demographic data were obtained. A Swan-Ganz catheter was inserted before beginning the cardiac operation. The PAP was recorded before induction of general anesthesia. Holter-monitoring was performed for 72 hours after the cardiac surgery. The primary endpoint was the overall occurrence of POAF. Results : Overall POAF occurred in 29 (26.6%) of the 109 patients. Compared to patients with no POAF, the patients who developed POAF had larger left atrial sizes (4.2 ± 0.4 versus 3.7 ± 0.4 cm, p
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ABSTRACT: Background- Atrial fibrillation (AF) is the most common complication after cardiac surgery and a major cause of morbidity and increased cost of care. Suitable treatment and prevention of postoperative AF are important for patients' improved health and rehabilitation. This study evaluates the risk factors of paroxysmal AF in patients who underwent valvular heart surgery. Method- Between April and October 2006, 392 patients who underwent heart valve surgery at our center were included in this prospective study. All relevant clinical, echocardiographic, and laboratory data were gathered in all the patients. Results- Postoperative AF occurred in 52 (13.3%) patients. In the univariate analysis, the presence of aortic valve disease, mitral valve disease, dyslipidemia, preoperative digoxin consumption, postoperative adrenergic use, intra-aortic balloon pump (IABP) insertion in post-surgery intensive care unit, and large left atrium were significantly associated with the occurrence of postoperative AF (all P