Meta-analysis of amiodarone versus beta-blocker as a prophylactic therapy against atrial fibrillation following cardiac surgery

摘要

Background: Current guidelines recommend beta-blocker as the first-line preventive treatment of atrial fibrillation (AF) after cardiac surgery; if beta-blocker therapy is contraindicated, then amiodarone is recommended. There is still lack of strong evidence of directly comparing the efficacy of amiodarone and beta-blocker in preventing postoperative AF (POAF). Aim: This meta-analysis was to determine whether amiodarione and beta-blocker are equally effective and safe, or one is superior in preventing POAF. Methods: We searched the Medline, Web of Science, Cochrane Library databases and clinical trial databases for related articles published from January 1990 to October 2011. The primary outcome was development of AF after cardiac surgery. We used random-effects model when there was significant heterogeneity between trials and fixed-effects method when heterogeneity was negligible. Moreover, subgroup and sensitivity analyses were also performed. Results: We identified totally six trials, which involved 1033 patients. The amiodarone group did not significantly differ from the beta-blocker group in AF occurrence (risk ratio 0.77, 95% confidence interval 0.55 to 1.06, P = 0.11) or the length of hospital stay (weighted mean difference -0.05 day, 95% confidence interval -0.64 to 0.54, P = 0.86). Subgroup analysis stratified by different beta-blockers revealed that amiodarone significantly improved POAF as compared with propranolol. In addition, there was no difference in adverse events after operation. Conclusion: These data indicate that the occurrence of AF and length of hospital stay after surgery are similar in the amiodarone and beta-blocker groups.