Amiodarone versus beta-blockers for the prevention of postoperative atrial fibrillation after cardiac surgery: An updated systematic review and meta-analysis of randomised controlled trials

Radhyaksa Ardaya; Jenni Pratita; Nusaibah Nadia Juliafina; Farhan Haidar Fazlur Rahman; Kevin Leonardo

doi:10.12688/f1000research.121598.1

Home Browse Amiodarone versus beta-blockers for the prevention of postoperative...

ALL Metrics

-

Views

-

Downloads

Get PDF

Get XML

Export

▬

✚

Systematic Review

Amiodarone versus beta-blockers for the prevention of postoperative atrial fibrillation after cardiac surgery: An updated systematic review and meta-analysis of randomised controlled trials

[version 1; peer review: 1 approved with reservations]

Radhyaksa Ardaya ¹, Jenni Pratita^1,2, Nusaibah Nadia Juliafina^3,4, Farhan Haidar Fazlur Rahman^3,5, Kevin Leonardo^6,7

Radhyaksa Ardaya ¹, Jenni Pratita^1,2, [...] Nusaibah Nadia Juliafina^3,4, Farhan Haidar Fazlur Rahman^3,5, Kevin Leonardo^6,7

PUBLISHED 25 May 2022

Author details Author details

¹ Division of Surgical and Interventional Sciences, University College London Medical School, London, WC1E 6BT, UK
² Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Jakarta, 10430, Indonesia
³ Metropolitan Medical Centre Hospital, Jakarta, 12940, Indonesia
⁴ Faculty of Medicine, University of Indonesia, Jakarta, 10430, Indonesia
⁵ Faculty of Medicine, Airlangga University, Surabaya, 60132, Indonesia
⁶ Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Daerah Istimewa Yogyakarta, 55281, Indonesia
⁷ Eka Hospital, Bumi Serpong Damai, 15321, Indonesia

Radhyaksa Ardaya
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Jenni Pratita
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Nusaibah Nadia Juliafina
Roles: Conceptualization, Data Curation, Investigation, Methodology, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Farhan Haidar Fazlur Rahman
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Software, Validation, Visualization, Writing – Review & Editing

Kevin Leonardo
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Software, Validation, Visualization, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background: Amiodarone and beta-blockers are widely used as prophylaxis for postoperative atrial fibrillation (AF). The current recommendations from society guidelines are inconclusive, leading to differing practices among physicians. This meta-analysis aimed to compare the efficacy of both agents in preventing postoperative AF after cardiac surgery.
Methods: We explored online medical databases, such as CINAHL, CENTRAL, MEDLINE, and EMBASE for randomised controlled trials (RCTs) comparing amiodarone and beta-blocker for prevention of AF after cardiac surgery. Outcomes analysed in this study were AF number of events and duration, hospital stay, and mean ventricular rate. Heterogeneity was assessed using the I² test, and publication bias was analysed using Egger’s test.
Results: In total, eight RCTs comprising 1370 patients met the inclusion criteria. Pooled analysis showed that patients in both groups had no significant difference in both AF episodes (RR 0.83, 95% CI 0.66 to 1.04, p=0.10) and AF duration (SMD 0.46, 95% CI -1.14 to 2.05, p=0.57). Furthermore, secondary outcome analysis on mean ventricular rate and mean hospital length of stay in both groups showed no significant difference (MD -4.48, 95% CI -14.36 to 5.39, p=0.37 and MD 0.29, 95% CI -0.06 to 0.63, p=0.11, respectively).
Conclusions: Amiodarone and beta-blockers are equally effective in preventing postoperative atrial fibrillation after cardiac surgery, with no difference in AF episode and duration, mean ventricular rate, and hospital length of stay.

Keywords

Atrial fibrillation, cardiac surgery, amiodarone, beta-blockers

Corresponding author: Radhyaksa Ardaya

Competing interests: No competing interests were disclosed.

Grant information: This work was supported by Lembaga Pengelola Dana Pendidikan (LPDP), awarded to RA. We confirm that the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2022 Ardaya R et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Ardaya R, Pratita J, Juliafina NN et al. Amiodarone versus beta-blockers for the prevention of postoperative atrial fibrillation after cardiac surgery: An updated systematic review and meta-analysis of randomised controlled trials [version 1; peer review: 1 approved with reservations]. F1000Research 2022, 11:569 (https://doi.org/10.12688/f1000research.121598.1) First published: 25 May 2022, 11:569 (https://doi.org/10.12688/f1000research.121598.1) Latest published: 25 May 2022, 11:569 (https://doi.org/10.12688/f1000research.121598.1)

Introduction

Atrial fibrillation (AF) is a common complication after cardiac surgeries with incidence ranging from 10% to 65% despite the latest developments in both surgical and medical management.¹ Postoperative AF could lead to prolonged intensive care unit (ICU) and hospital stay, resulting in increased cost. Although its mortality rate is low, it frequently induces hemodynamic disturbance and thromboembolic events.¹^,² The hypothesized pathophysiology of postoperative AF is the interaction between acute surgery-related factors, including activated sympathetic nervous system and renin-angiotensin-aldosterone system, inflammation, trauma and oxidative stress, and underlying abnormal atrial substrate which induces electrical instability.³

Pharmacological and non-pharmacological measures (e.g. atrial pacing) are used as strategies to prevent postoperative AF. Both beta-blockers and antiarrhythmics such as amiodarone could be used in postoperative AF prevention. Beta-blockers lower myocardial oxygen demand and ischemia events in the postoperative period by lessening the chronotropic and inotropic effects of catecholamine surge.³ Meanwhile, amiodarone prevents AF primarily by blocking potassium channels and through its anti-adrenergic effect, thus decreasing myocyte excitability, and preventing the re-entry mechanism and ectopic foci from causing an arrhythmia.³^,⁴ Both drugs can be administered either orally or intravenously, although the latter route may be more effective.⁵ However, previous studies on the efficacy of these drugs provide conflicting results.

As a result, the gold standard regimen of postoperative AF prevention remains uncertain, resulting in varying practices and a high discontinuation rate, which might increase the patient’s risk of developing arrhythmias.¹^,² Therefore, this study aims to compare the efficacy of these drugs in preventing postoperative AF.

Objectives

The objectives of this research are to compare the efficacy of amiodarone and beta-blockers in preventing postoperative AF after cardiac surgery.

Methods

We explored online medical databases, such as CINAHL, CENTRAL (Cochrane Library), MEDLINE (PubMed), and EMBASE (Science Direct), for a literature search from 11^th January to 18^th February 2022. The literature search process was performed using medical subject headings (MeSH) terms of (“coronary artery bypass graft”) AND (“amiodarone”) AND (“beta-blocker”). The search process was done according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines (see Reporting guidelines⁴⁸). The literature searching and selection process were performed by all of the authors unfetteredly.

Eligibility criteria

A study was included if it met the following criteria: a study evaluating amiodarone and beta-blockers in patients who underwent cardiac surgery (coronary artery bypass grafting (CABG), valve repair/replacement, and both), available in full text, and written in English. Our exclusion criteria were studies which full text were not available, non-randomised studies, and studies with irrelevant outcomes. The evaluated effects should include the following parameters: AF number of events and duration, mean ventricular rate, and length of hospital stay.

Data collection and statistical analysis

All authors were involved in data collection and worked independently. The main author collected the data manually from each author and any disagreement between authors were resolved through discussion. Included studies were examined using the EndNote 20 software for possible study duplication. Alternatively, this process can also be replicated using the Mendeley Reference Manager software. All statistical analysis was performed using STATA 17 software by StataCorp, California, USA, and Review Manager (RevMan) 5.4 software by Cochrane, Oxford, United Kingdom.

Data items

All eight studies investigated AF episodes, which we used as the primary outcome. Secondary outcomes were determined based on comparable outcomes reported among the studies (AF duration, mean ventricular rate, and mean length of hospital stay).

Study risk of bias assessment

Randomised study quality was assessed using the Cochrane Risk Index of Bias tools. All authors performed bias assessment independently and disagreements were resolved through discussion.

Effect measures

If the data extracted were binary outcomes, statistical calculation such as risk ratio (RR) or odds ratio (OR) would be selected. Meanwhile, if the data extracted were continuous outcomes, statistical calculation such as mean difference (MD) and standardized mean difference (SMD) would be chosen.

Synthesis methods

I² result would determine the heterogeneity test result. If the I² test result were less than fifty percent, a fixed-effect model would be selected since the heterogeneity was considered to be insignificant. Otherwise, a random-effect model would be chosen. All analyses used 95% of confidence intervals. P-value of less than 0.05 is considered to be statistically significant.

Reporting bias assessment

Reporting bias of each study was assessed using the assessed using the Cochrane Risk Index of Bias tools. Studies with high risk of reporting bias were not included in this study.

Certainty assessment

We used GRADE (grading of recommendations assessment, development and evaluation) approach to assess the certainty in the body of evidence. All authors performed the assessment independently, and disagreements between assessors were resolved through discussion between assessors.

Results

The article selection process was carried out according to PRISMA guidelines. Initial study searching resulted in 186 articles, which all were processed using the EndNote application for study duplication. According to our inclusion criteria, the remaining 155 studies were then assessed manually by all authors. As many as thirteen articles were further analysed for eligibility, resulting in eight studies¹^,⁵^–¹¹ analysed for final qualitative and quantitative analysis. The assessment of bias in the studies were conducted using Cochrane’s risk-of-bias tool, with the result listed in Table 1.

Table 1. Quality assessment of the included studies.

	Random sequence generation	Allocation concealment	Blinding of participants and personnel	Blinding of outcome assessment	Incomplete outcome data	Selective reporting	Other bias
Bigdelian et al.	Low	Low	Unclear	Unclear	Unclear	Low	Unclear
Halonen et al.	Low	Low	High	High	Low	Low	Low
Hassan et al.	Unclear	Unclear	Unclear	Unclear	Low	Low	Unclear
Kojuri et al.	Unclear	Unclear	Low	Low	Low	Low	Low
Mooss et al.	Unclear	Low	Unclear	Unclear	Low	Low	Low
Onk et al.	Unclear	Unclear	Unclear	Low	Low	Low	Unclear
Sleilaty et al.	Low	High	High	High	Low	Low	High
Solomon et al.	Unclear	Unclear	Unclear	Low	Low	Low	High

This study analysed four outcomes: number of AF episodes, AF duration, mean ventricular rate, and length of hospital stay. The authors, publication year, nation, sample size, mean age, surgery types, outcome, and follow up time were all extracted from the studies and presented in Table 2, while the treatment protocol details (type of drugs, dosage, timing, and duration of the treatment) of the included studies were elaborated in Table 3. AF episodes are presented in risk ratio (RR). AF duration is presented in standardized mean differences (SMD), and the secondary outcomes are presented in mean difference (MD). All analyses used 95% of confidence intervals. P-value of less than 0.05 is considered to be statistically significant.

Table 2. Characteristics of studies included in the meta-analysis.

Study Author/Year/Country	Sample size		Mean age (years)	Surgery type	Outcomes	Follow-up time
Study Author/Year/Country	Amio-darone	Beta-blockers	Mean age (years)	Surgery type	Outcomes	Follow-up time
Bigdelian/2008/Iran	65	65	55	Elective CABG (on pump), valve surgery, CABG with valve surgery	Primary: AF incidence Secondary: number of AF episodes, ventricular rate, time to onset of AF, longest AF duration, LOS, ICU stay, complications	6-days post-surgery or until hospital discharge
Halonen/2010/Finland	157	159	64.15	Elective CABG (on pump) with/without aortic valve surgery	Primary: AF incidence Secondary: time to onset of AF, ventricular rate, complications, death	48-hours post-surgery (primary end point), then until hospital discharge
Hassan/2013/India	20	30	47	Open heart surgery on cardiopulmonary bypass (repair of congenital defects, valve replacements)	Primary: AF Incidence Secondary: time to onset of AF, AF duration, ventricular rate, LOS, cost, complications, death	Until hospital discharge
Kojuri/2009/Iran	80	80	59.75	Elective CABG (on pump)	Primary: AF incidence Secondary: correlation between risk factors and incidence of AF, 30-day mortality	5-days post-surgery for primary outcome, then until 30-days post-surgery for secondary outcome (mortality rate)
Mooss/2004/USA	83	76	65	CABG (on pump), AVR, CABG with AVR	Primary: AF incidence, incidence of drug-related side effects Secondary: AF duration, number of AF episodes, time to onset of AF, LOS, hemodynamic changes, use of vasoactive drugs, complications, death	7-days post-surgery or until hospital discharge (primary end-point), then at 1 month after hospital discharge
Onk/2005/Turkey	122	129	57.65	CABG (on pump)	Primary: AF incidence Secondary: use of IABP, use of inotropic agents, LOS, ICU stay, hospital mortality, complications, survival rate	2-days post-surgery (primary end-point), then at 4-weeks post-surgery
Sleilaty/2009/Lebanon	98	102	61.65	Elective CABG (on pump) with/without mitral valve repair	Primary: AF incidence Secondary: maximal ventricular rate, time to onset of AF, AF duration, AF recurrence, LOS, ICU stay, low cardiac output	Until hospital discharge, then at 1 month post-surgery to assess recurrence
Solomon/2001/USA	50	52	65.35	Elective CABG (on pump), valve surgery, CABG with valve surgery	Primary: AF incidence Secondary: time to onset of AF, number of AF episodes, AF duration, ventricular rate, LOS, ECG data, complications	Until hospital discharge or at least 7-days post-surgery

Table 3. Treatment protocol of the studies included in the meta-analysis.

Study Author/Year/Country	Amiodarone dosage	Beta-blockers dosage
Bigdelian/2008/Iran	150 mg IV during 30 minutes after surgery, then continued with 150 mg/6 hours IV for 48 hours and followed by 400 mg/12 hour orally until hospital discharge	Immediately after surgery as 10 mg oral single dose, then continued with 10 mg/8 hours for 6 days
Halonen/2010/Finland	15 mg/kg BW/day, IV, with maximum daily dose 1000 mg, started on first post-operative day, 15-21 hours post-surgery, continued for 48 hours	Metoprolol infusion IV 1 mg/hours for HR 60-70 bpm, 2 mg/hours for HR 70-80 bpm, or 3 mg/hours for HR >80 bpm, started on first post-operative day, 15-21 hours post-surgery, continued for 48 hours
Hassan/2013/India	10 mg/kg BW/day orally, started 2 weeks before surgery and continued until hospital discharge	Metoprolol 25 mg/8 hours orally for HR 60-70 bpm, 50 mg/12 hours for HR 70-80 bpm, 50 mg/8 hours for HR >80 bpm; started 2 weeks before surgery and continued until hospital discharge
Kojuri/2009/Iran	200 mg/12 hours orally, started 7 days before surgery until 5 days post-surgery	Propranolol 20 mg/12 hours orally, started 7 days before surgery until 5 days post-CABG
Mooss/2004/USA	15 mg/kg BW, IV, over 24 hours started at time of surgery, then switched to 200 mg/8 hours orally until 7 days	D,L-sotalol 80 mg orally, started 2 hours before surgery, then 80 mg/12 hours orally until 7 days
Onk/2005/Turkey	200 mg/8 hours orally, started 1 week before surgery and continued during post-operative period	Metoprolol 50 mg/12 hours orally, started 1 week before surgery and continued during post-operative period
Sleilaty/2009/Lebanon	15 mg/kg orally via gastric tube started on first day post-surgery, then 7mg/kg/day orally until hospital discharge, then 200 mg/day for one month	Bisoprolol 2.5 mg orally via gastric tube started on first day post-surgery, then 2.5 mg/12 hours continued indefinitely
Solomon/2001/USA	1 g/24 hours IV infusion for 48 hours, started within 3 hours post-surgery, continued with 400 mg/day orally until hospital discharge	Propranolol 1 mg/6 hour IV for 48 hours, started within 3 hours post-surgery, then 10 mg orally as test dose, then titrated to 20 mg/6 hours orally if HR remained >60 bpm and BP >100 mmHg, continued until hospital discharge

AF episodes

A total of eight studies including 1370 participants met the inclusion criteria for the comparison of AF episode analysis. Pooled analysis in Figure 1 showed no significant difference in AF episodes between the amiodarone group and beta-blocker group (RR 0.83, 95% CI 0.66, 1.04, p=0.10).

Figure 1. Forest plot of amiodarone and beta-blocker effect on AF episodes.

AF duration

Three studies, including 384 participants, allocated into the amiodarone group (n=189) and beta-blocker group (n=195) compared the duration of AF. In accordance to the comparable risk of AF episode, pooled analysis in Figure 2 also showed no significant difference in terms of AF duration between both groups (SMD 0.46, 95% CI -1.1 to 2.05, p=0.57).

Figure 2. Forest plot of amiodarone and beta-blocker effect on AF duration.

Mean ventricular rate

Mean ventricular rate comparison in Figure 3 was performed using fixed-effect model (I²=0%), resulting in not significant mean difference in mean ventricular rate comparison between both groups (MD -4.48, 95% CI -14.36 to 5.39, p=0.37).

Figure 3. Forest plot of amiodarone and beta-blocker effect on mean ventricular rate.

Mean length of hospital stay

Four studies with 676 participants reported the difference in mean length of hospital stay. Figure 4 showed that there was no difference in mean length of hospital stay between both groups (MD 0.29, 95% CI -0.06 to 0.63, p=0.11).

Figure 4. Forest plot of amiodarone and beta-blocker effect on length of hospital stay.

Reporting biases

All studies included in this meta-analysis are considered low risk of reporting bias.

Certainty of evidence

Assessment of evidence certainty for all outcomes in this meta-analysis resulted in moderate certainty.

Discussion

Postoperative AF remains the most common complication in cardiac surgery patients. The incidence varies depending on the procedure, occurring after around 30% of coronary artery bypass grafting (CABG) surgery, 40% of valve repair and replacement surgeries, and about 50% in combined cardiac procedures.¹² According to the guideline by the American Heart Association/American College of Cardiology and the Heart Rhythm Society in 2014 on the management of AF, preoperative administration of amiodarone is recommended before cardiac surgery on patients with increased risk of developing postoperative AF (Class IIa, Level of Evidence A).¹³ Risk factors for developing postoperative AF include advanced age, male gender, previous history of AF, diabetes mellitus, and the presence of left atrial enlargement, which are similar to the characteristics of most patients undergoing cardiac surgery. On the other hand, the European Society of Cardiology (ESC), in their most recent guideline on diagnosis and management of AF, recommended routine perioperative administration of amiodarone or beta-blockers regardless of risk factor status (Class I, Level of Evidence A).¹⁴ Although the recent guidelines have signified the importance of therapeutic agents administration as a prophylaxis for postoperative AF, there is another issue on whether amiodarone or beta-blockers should be given for better outcomes.

In our meta-analysis comprising eight studies, there was no difference in postoperative AF episodes between the amiodarone and beta-blockers groups. This result supports the findings from a similar meta-analysis conducted in 2012.¹⁵ Furthermore, this study found no difference between both groups in duration of AF, hospital length of stay, and mean ventricular rate. It could be implied that both drugs are equally effective in preventing postoperative AF. Therefore, in clinical practice, it is more appropriate to make an individual decision for each case rather than to follow a prespecified general guideline.

Beta-blockers should be the agent of choice for patients with multiple risk factors who are already receiving long-term beta-blockers, as abrupt discontinuation of beta-blockers before surgery is associated with two- to fivefold increased risk of developing postoperative AF.³^,¹⁴ On the other hand, it might not be suitable for urgent patients without a history of prior use of the agent as it should be initiated two to seven days before surgery.¹⁶^–¹⁸ Extra caution should also be taken when beta-blockers are administered to patients without a history of previous use, as some patients may develop bronchospasm.¹³ Another issue is choosing the preferred variant of beta-blocker. Carvedilol has shown an 18 to 20% higher reduction of postoperative AF than metoprolol, although the length of hospital stay was equal.¹⁹^–²² A more recent type of beta-blocker is sotalol, which exhibits class III antiarrhythmic effects on top of typical beta-blocker features.³ Several studies have demonstrated the superiority of sotalol when compared to conventional beta-blockers to prevent postoperative AF, although the sotalol group developed more side effects such as bradycardia and hypotension.²³^–²⁶

Amiodarone, which plays a role in both rate control and rhythm control strategies, has been demonstrated to reduce the risk of postoperative AF by 12 to 51% when compared to placebo.²⁷^–³⁰ It is equally effective when given in different doses (low dose <3g), medium dose 3 – 5 g, and high dose > 5g), timing (pre/post operative), and through either routes (oral/IV).³¹^,³² However, there is a rising concern regarding safety, as evidenced by a meta-analysis that reported an increased risk of hypotension, prolonged QT interval, and bradycardia in the amiodarone group when compared to placebo. Other extracardiac adverse effects from amiodarone include thyroid, hepatic, and pulmonary toxicities.³³

The emergence of alternative options for preventing postoperative AF, such as corticosteroids, colchicine, and statins may be considered in an individualised manner.³⁴^–³⁶ Corticosteroids, for example, were demonstrated to further reduce the incidence of postoperative AF when combined with beta-blockers, although the length of hospital stay was not different.³⁷^,³⁸ The overall use of corticosteroids is low due to the popular belief that they are associated with multiple risks.³⁹ Nonetheless, although corticosteroids use is associated with increased risk of hyperglycaemia, several studies reported that administration of corticosteroids did not increase the risk of infection, bleeding, and stroke.⁴⁰^,⁴¹

Longer AF duration (>24 h per week) is associated with a higher mortality risk. However, there is no evidence whether this is appropriate for postoperative AF.⁴² Longer AF duration is also associated with an increased risk of stroke, but there was not enough data in the studies included in this meta-analysis to assess either stroke or mortality as a secondary outcome.⁴³

Both amiodarone and beta-blockers have been widely utilised in the therapy of postoperative AF, with current evidence reporting comparable outcomes between both agents.³⁰^,⁴⁴^,⁴⁵ Beta-blockers are one of the medications used in rate control strategy, while amiodarone plays a role in both rate control and rhythm control approaches.¹⁴ In the RACE (Rate Control Efficacy in Permanent Atrial Fibrillation) II trial, patients set to a stricter limit [heart rate < 80 beats per minute (bpm)] were not associated with lower morbidity, mortality, and hospitalisation when compared to the more lenient group (heart rate <110 bpm).⁴⁶ In postoperative AF, both rate control and rhythm control approaches have shown similar complication rates and equal days of hospitalisation.⁴⁷

There were a few notable limitations in this study. More recent studies investigated the use of less conventional drugs to prevent postoperative AF, resulting in a scarcity of newer trials comparing amiodarone and beta-blockers. It was not possible to examine the risk of bradycardia, hypotension, stroke, and mortality, which are commonly associated with atrial fibrillation, due to a lack of data. It should also be pointed out that in this study, we compared amiodarone with all types of beta-blockers, including sotalol. Each beta-blocker differs in properties, and some patients may benefit more from a specific type of beta-blockers but less from another.

Future research on specific population (e.g., diabetes, older age, previous history of AF) undergoing cardiac surgeries are needed to understand the efficacy and risk associated with each agent commonly used to prevent postoperative AF. Additionally, more studies investigating the efficacy and safety of emerging unconventional drugs as a first-line prophylaxis is required as existing studies have reported conflicting results.

Conclusions

Our meta-analysis showed that the use of either amiodarone or beta-blockers for the prevention of postoperative AF after cardiac surgery results in comparable AF episodes, duration, mean ventricular rate and hospital length of stay. The drug of choice for each patient should therefore be personalised based on the pre-existing medical conditions.

Data availability

Underlying data

All data underlying the results are available as part of the article and no additional source data are required.

Reporting guidelines

Open Science Framework: PRISMA checklist and flow diagram for ‘Amiodarone versus beta-blockers for the prevention of postoperative atrial fibrillation after cardiac surgery: An updated systematic review and meta-analysis of randomised controlled trials’, https://doi.org/10.17605/OSF.IO/CUYH9.⁴⁸

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

References

1. Onk OA, Erkut B: Is the preoperative administration of amiodarone or metoprolol more effective in reducing atrial fibrillation: after coronary bypass surgery?. Medicine. 2015; 94(41): e1576. PubMed Abstract | Publisher Full Text
2. Piccini JP, Zhao Y, Steinberg BA, et al.: Comparative effectiveness of pharmacotherapies for prevention of atrial fibrillation following coronary artery bypass surgery. Am. J. Cardiol. 2013; 112(7): 954–960. PubMed Abstract | Publisher Full Text
3. Turagam MK, Downey FX, Kress DC, et al.: Pharmacological strategies for prevention of postoperative atrial fibrillation. Expert. Rev. Clin. Pharmacol. 2015; 8(2): 233–250. PubMed Abstract | Publisher Full Text
4. Javot L, Pape E, Yéléhé-Okouma M, et al.: Intravenous single administration of amiodarone and breastfeeding. Fundam. Clin. Pharmacol. 2019; 33(3): 367–372. PubMed Abstract | Publisher Full Text
5. Halonen J, Loponen P, Järvinen O, et al.: Metoprolol versus amiodarone in the prevention of atrial fibrillation after cardiac surgery: a randomized trial. Ann. Intern. Med. 2010; 153(11): 703–709. PubMed Abstract | Publisher Full Text
6. Bigdelian H, Gharipour M, Behdad GR, et al.: The effect of amiodarone versus propanolol for prophylaxis of atrial fibrillation af-ter cabg in low ef patients.2009.
7. Kojuri J, Mahmoodi Y, Jannati M, et al.: Ability of amiodarone and propranolol alone or in combination to prevent post-coronary bypass atrial fibrillation. Cardiovasc. Ther. 2009; 27(4): 253–258. PubMed Abstract | Publisher Full Text
8. Mooss AN, Wurdeman RL, Sugimoto JT, et al.: Amiodarone versus sotalol for the treatment of atrial fibrillation after open heart surgery: the Reduction in Postoperative Cardiovascular Arrhythmic Events (REDUCE) trial. Am. Heart J. 2004; 148(4): 641–648. PubMed Abstract | Publisher Full Text
9. Nayeem-ul-hassan AMD, Wani ML, Rather HA, et al.: A comparative study on the effect of amiodarone and metaprolol for prevention of arrythmias after open heart surgery. Int. Cardiovasc. Res. J. 2013; 7(1): 1–4. PubMed Abstract
10. Sleilaty G, Madi-Jebara S, Yazigi A, et al.: Postoperative oral amiodarone versus oral bisoprolol as prophylaxis against atrial fibrillation after coronary artery bypass graft surgery: a prospective randomized trial. Int. J. Cardiol. 2009; 137(2): 116–122. PubMed Abstract | Publisher Full Text
11. Solomon AJ, Greenberg MD, Kilborn MJ, et al.: Amiodarone versus a β-blocker to prevent atrial fibrillation after cardiovascular surgery. Am. Heart J. 2001; 142(5): 811–815. PubMed Abstract | Publisher Full Text
12. Echahidi N, Pibarot P, O’Hara G, et al.: Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J. Am. Coll. Cardiol. 2008; 51(8): 793–801. Publisher Full Text
13. January CT, Wann LS, Alpert JS, et al.: 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J. Am. Coll. Cardiol. 2014; 64(21): e1–e76. PubMed Abstract | Publisher Full Text
14. Hindricks G, Potpara T, Dagres N, et al.: 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021; 42(5): 373–498. PubMed Abstract | Publisher Full Text
15. Zhu J, Wang C, Gao D, et al.: Meta-analysis of amiodarone versus beta-blocker as a prophylactic therapy against atrial fibrillation following cardiac surgery. Intern. Med. J. 2012; 42(10): 1078–1087. PubMed Abstract | Publisher Full Text
16. Fleisher LA, Fleischmann KE, Auerbach AD, et al.: 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J. Am. Coll. Cardiol. 2014; 64(22): e77–e137. PubMed Abstract | Publisher Full Text
17. Kristensen SD, Knuuti J: New ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Oxford University Press;2014; 2344–2345.
18. Bouri S, Shun-Shin MJ, Cole GD, et al.: Meta-analysis of secure randomised controlled trials of β-blockade to prevent perioperative death in non-cardiac surgery. Heart. 2014; 100(6): 456–464. PubMed Abstract | Publisher Full Text
19. Acikel S, Bozbas H, Gultekin B, et al.: Comparison of the efficacy of metoprolol and carvedilol for preventing atrial fibrillation after coronary bypass surgery. Int. J. Cardiol. 2008; 126(1): 108–113. PubMed Abstract | Publisher Full Text
20. Haghjoo M, Saravi M, Hashemi MJ, et al.: Optimal β-blocker for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery: carvedilol versus metoprolol. Heart Rhythm. 2007; 4(9): 1170–1174. PubMed Abstract | Publisher Full Text
21. Merritt JC, Niebauer M, Tarakji K, et al.: Comparison of effectiveness of carvedilol versus metoprolol or atenolol for atrial fibrillation appearing after coronary artery bypass grafting or cardiac valve operation. Am. J. Cardiol. 2003; 92(6): 735–736. Publisher Full Text
22. Wang H-S, Wang Z-W, Yin Z-T: Carvedilol for prevention of atrial fibrillation after cardiac surgery: a meta-analysis. PLoS One. 2014; 9(4): e94005. PubMed Abstract | Publisher Full Text
23. Patel A, Dunning J: Is Sotalol more effective than standard beta-blockers for the prophylaxis of atrial fibrillation during cardiac surgery. Interact. Cardiovasc. Thorac. Surg. 2005; 4(2): 147–150. PubMed Abstract | Publisher Full Text
24. Burgess DC, Kilborn MJ, Keech AC: Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur. Heart J. 2006; 27(23): 2846–2857. PubMed Abstract | Publisher Full Text
25. Evrard P, Gonzalez M, Jamart J, et al.: Prophylaxis of supraventricular and ventricular arrhythmias after coronary artery bypass grafting with low-dose sotalol. Ann. Thorac. Surg. 2000; 70(1): 151–156. PubMed Abstract | Publisher Full Text
26. Weber UK, Osswald S, Huber M, et al.: Selective versus non-selective antiarrhythmic approach for prevention of atrial fibrillation after coronary surgery: is there a need for pre-operative risk stratification? A prospective placebo-controlled study using low-dose sotalol. Eur. Heart J. 1998; 19(5): 794–800. PubMed Abstract
27. Guarnieri T, Nolan S, Gottlieb SO, et al.: Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery: the Amiodarone Reduction in Coronary Heart (ARCH) trial. J. Am. Coll. Cardiol. 1999; 34(2): 343–347. PubMed Abstract | Publisher Full Text
28. Daoud EG, Strickberger SA, Man KC, et al.: Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N. Engl. J. Med. 1997; 337(25): 1785–1791. PubMed Abstract | Publisher Full Text
29. Barnes BJ, Kirkland EA, Howard PA, et al.: Risk-stratified evaluation of amiodarone to prevent atrial fibrillation after cardiac surgery. Ann. Thorac. Surg. 2006; 82(4): 1332–1337. PubMed Abstract | Publisher Full Text
30. Auer J, Weber T, Berent R, et al.: A comparison between oral antiarrhythmic drugs in the prevention of atrial fibrillation after cardiac surgery: the pilot study of prevention of postoperative atrial fibrillation (SPPAF), a randomized, placebo-controlled trial. Am. Heart J. 2004; 147(4): 636–643. PubMed Abstract | Publisher Full Text
31. Buckley MS, Nolan PE Jr, Slack MK, et al.: Amiodarone Prophylaxis for Atrial Fibrillation After Cardiac Surgery: Meta-Analysis of Dose Response and Timing of Initiation. Pharmacotherapy. 2007; 27(3): 360–368. PubMed Abstract | Publisher Full Text
32. Chatterjee S, Sardar P, Mukherjee D, et al.: Timing and Route of Amiodarone for Prevention of Postoperative Atrial Fibrillation after Cardiac Surgery: A Network Regression Meta-analysis. Pacing Clin. Electrophysiol. 2013; 36(8): 1017–1023. PubMed Abstract | Publisher Full Text
33. Patel AA, White CM, Gillespie EL, et al.: Safety of amiodarone in the prevention of postoperative atrial fibrillation: a meta-analysis. Am. J. Health Syst. Pharm. 2006; 63(9): 829–837. PubMed Abstract | Publisher Full Text
34. Wang W, Mei YQ, Yuan XH, et al.: Clinical efficacy of epicardial application of drug-releasing hydrogels to prevent postoperative atrial fibrillation. J. Thorac. Cardiovasc. Surg. 2016; 151(1): 80–85. PubMed Abstract | Publisher Full Text
35. Tabbalat RA, Hamad NM, Alhaddad IA, et al.: Effect of colchicine on the incidence of atrial fibrillation in open heart surgery patients: END-AF trial. Am. Heart J. 2016; 178: 102–107. PubMed Abstract | Publisher Full Text
36. Yuan X, Du J, Liu Q, et al.: Defining the role of perioperative statin treatment in patients after cardiac surgery: A meta-analysis and systematic review of 20 randomized controlled trials. Int. J. Cardiol. 2017; 228: 958–966. PubMed Abstract | Publisher Full Text
37. Prasongsukarn K, Abel JG, Jamieson WE, et al.: The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: a prospective randomized trial. J. Thorac. Cardiovasc. Surg. 2005; 130(1): 93–98. PubMed Abstract | Publisher Full Text
38. Halonen J, Halonen P, Järvinen O, et al.: Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. JAMA. 2007; 297(14): 1562–1567. Publisher Full Text
39. Philip I, Berroëta C, Leblanc I: Perioperative challenges of atrial fibrillation. Curr. Opin. Anaesthesiol. 2014; 27(3): 344–352. PubMed Abstract | Publisher Full Text
40. Dieleman JM, Nierich AP, Rosseel PM, et al.: Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial. JAMA. 2012; 308(17): 1761–1767. PubMed Abstract | Publisher Full Text
41. Ho KM, Tan JA: Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery: a dose-response meta-analysis. Circulation. 2009; 119(14): 1853–1866. PubMed Abstract | Publisher Full Text
42. Piccini JP, Passman R, Turakhia M, et al.: Atrial fibrillation burden, progression, and the risk of death: a case-crossover analysis in patients with cardiac implantable electronic devices. EP Europace. 2019; 21(3): 404–413. PubMed Abstract | Publisher Full Text
43. Kaplan RM, Koehler J, Ziegler PD, et al.: Stroke risk as a function of atrial fibrillation duration and CHA2DS2-VASc score. Circulation. 2019; 140(20): 1639–1646. PubMed Abstract | Publisher Full Text
44. Cagli K, Ozeke O, Ergun K, et al.: Effect of low-dose amiodarone and magnesium combination on atrial fibrillation after coronary artery surgery. J. Card. Surg. 2006; 21(5): 458–464. PubMed Abstract | Publisher Full Text
45. White CM, Caron MF, Kalus JS, et al.: Intravenous plus oral amiodarone, atrial septal pacing, or both strategies to prevent post-cardiothoracic surgery atrial fibrillation: the Atrial Fibrillation Suppression Trial II (AFIST II). Circulation. 2003; 108(10_suppl_1): II-200–II-206. Publisher Full Text
46. Van Gelder IC, Groenveld HF, Crijns HJ, et al.: Lenient versus strict rate control in patients with atrial fibrillation. N. Engl. J. Med. 2010; 362(15): 1363–1373. PubMed Abstract | Publisher Full Text
47. Gillinov AM, Bagiella E, Moskowitz AJ, et al.: Rate control versus rhythm control for atrial fibrillation after cardiac surgery. N. Engl. J. Med. 2016; 374(20): 1911–1921. PubMed Abstract | Publisher Full Text
48. Ardaya R: Extended data for "Amiodarone versus beta-blockers for the prevention of postoperative atrial fibrillation after cardiac surgery: An updated systematic review and meta-analysis of randomised controlled trials".2022, May 13. Publisher Full Text

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 25 May 2022

Author details Author details

¹ Division of Surgical and Interventional Sciences, University College London Medical School, London, WC1E 6BT, UK
² Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Jakarta, 10430, Indonesia
³ Metropolitan Medical Centre Hospital, Jakarta, 12940, Indonesia
⁴ Faculty of Medicine, University of Indonesia, Jakarta, 10430, Indonesia
⁵ Faculty of Medicine, Airlangga University, Surabaya, 60132, Indonesia
⁶ Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Daerah Istimewa Yogyakarta, 55281, Indonesia
⁷ Eka Hospital, Bumi Serpong Damai, 15321, Indonesia

Radhyaksa Ardaya
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Jenni Pratita
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Nusaibah Nadia Juliafina
Roles: Conceptualization, Data Curation, Investigation, Methodology, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Farhan Haidar Fazlur Rahman
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Software, Validation, Visualization, Writing – Review & Editing

Kevin Leonardo
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Software, Validation, Visualization, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

This work was supported by Lembaga Pengelola Dana Pendidikan (LPDP), awarded to RA. We confirm that the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Article Versions (1)

version 1

Published: 25 May 2022, 11:569

https://doi.org/10.12688/f1000research.121598.1

Copyright

© 2022 Ardaya R et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download

Export To

metrics

	Views	Downloads
F1000Research	-	-
PubMed Central Data from PMC are received and updated monthly.	-	-

Citations

0

SEE MORE DETAILS

CITE

how to cite this article

Ardaya R, Pratita J, Juliafina NN et al. Amiodarone versus beta-blockers for the prevention of postoperative atrial fibrillation after cardiac surgery: An updated systematic review and meta-analysis of randomised controlled trials [version 1; peer review: 1 approved with reservations]. F1000Research 2022, 11:569 (https://doi.org/10.12688/f1000research.121598.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

track

receive updates on this article

Track an article to receive email alerts on any updates to this article.

Open Peer Review

Version 1

VERSION 1

PUBLISHED 25 May 2022

Views

3

Reviewer Report 27 Oct 2023

Senem Ozgur, Department of Pediatric Cardiology/Electrophysiology, Dr. Sami Ulus Children Hospital Beştepe & Department of Pediatric Cardiology/Electrophysiology, Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center Hospital, Istanbul, Turkey; Pediatric Arrhythmia and Electrophysiology, Ankara Etlik City Hospital, Ankara, Anatolian, Turkey

Approved with Reservations

https://doi.org/10.5256/f1000research.133478.r215995

The paper's methodology is well expressed, its aims and results are clear and understandable. In this respect, it was able to directly convey the message the author wanted to give to the reader. Of course, as with all studies, it ... Continue reading

The paper's methodology is well expressed, its aims and results are clear and understandable. In this respect, it was able to directly convey the message the author wanted to give to the reader. Of course, as with all studies, it has certain limitations. However, I think it is a compilation that will shed light on the next updates on a subject that is still subject to debate and updates.

‘’Both beta-blockers and antiarrhythmics such as amiodarone could be used in postoperative AF prevention.’’

Beta blockers are also used as antiarrhythmics. This sentence implies that beta blockers are not antiarrhythmic. I think this sentence should be rearranged differently.
‘’As a result, the gold standard regimen of postoperative AF prevention remains uncertain, resulting in varying practices and a high discontinuation rate, which might increase the patient’s risk of developing arrhythmias ‘’

These two sentences should be separated from each other. An unnecessarily long sentence. Also, there is no cause-effect relationship between the first part of the sentence and the second part.
As the author already stated in the text, the studies examined and included are relatively old.
‘’A more recent type of beta-blocker is sotalol, which exhibits class III antiarrhythmic effects on top of typical beta-blocker features.3 ‘

Would it be more appropriate to define sotalol as a Class III (K channel inhibitor) that also has beta blocker activity?

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Pediatric Arrhythmia and Electrophysiology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

CITE

Report a concern

Respond or Comment

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 25 May 2022

Open Peer Review

Reviewer Status

Reviewer Reports

	Invited Reviewers
	1
Version 1 25 May 22	read

Senem Ozgur, Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center Hospital, Istanbul, Turkey; Ankara Etlik City Hospital, Ankara, Turkey

Comments on this article

All Comments(0)

Add a comment

Sign up for content alerts

Browse by related subjects

Back to all reports

Reviewer Report

3 Views

27 Oct 2023 | for Version 1

Senem Ozgur, Department of Pediatric Cardiology/Electrophysiology, Dr. Sami Ulus Children Hospital Beştepe & Department of Pediatric Cardiology/Electrophysiology, Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center Hospital, Istanbul, Turkey; Pediatric Arrhythmia and Electrophysiology, Ankara Etlik City Hospital, Ankara, Anatolian, Turkey

3 Views Cite this report Responses(0)

Approved With Reservations

The paper's methodology is well expressed, its aims and results are clear and understandable. In this respect, it was able to directly convey the message the author wanted to give to the reader. Of course, as with all studies, it has certain limitations. However, I think it is a compilation that will shed light on the next updates on a subject that is still subject to debate and updates.

‘’Both beta-blockers and antiarrhythmics such as amiodarone could be used in postoperative AF prevention.’’

Beta blockers are also used as antiarrhythmics. This sentence implies that beta blockers are not antiarrhythmic. I think this sentence should be rearranged differently.
‘’As a result, the gold standard regimen of postoperative AF prevention remains uncertain, resulting in varying practices and a high discontinuation rate, which might increase the patient’s risk of developing arrhythmias ‘’

These two sentences should be separated from each other. An unnecessarily long sentence. Also, there is no cause-effect relationship between the first part of the sentence and the second part.
As the author already stated in the text, the studies examined and included are relatively old.
‘’A more recent type of beta-blocker is sotalol, which exhibits class III antiarrhythmic effects on top of typical beta-blocker features.3 ‘

Would it be more appropriate to define sotalol as a Class III (K channel inhibitor) that also has beta blocker activity?

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Pediatric Arrhythmia and Electrophysiology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Respond to this report

Responses (0)

[1] 1. Onk OA, Erkut B: Is the preoperative administration of amiodarone or metoprolol more effective in reducing atrial fibrillation: after coronary bypass surgery?. Medicine. 2015; 94(41): e1576. PubMed Abstract | Publisher Full Text

[2] 2. Piccini JP, Zhao Y, Steinberg BA, et al.: Comparative effectiveness of pharmacotherapies for prevention of atrial fibrillation following coronary artery bypass surgery. Am. J. Cardiol. 2013; 112(7): 954–960. PubMed Abstract | Publisher Full Text

[3] 3. Turagam MK, Downey FX, Kress DC, et al.: Pharmacological strategies for prevention of postoperative atrial fibrillation. Expert. Rev. Clin. Pharmacol. 2015; 8(2): 233–250. PubMed Abstract | Publisher Full Text

[4] 4. Javot L, Pape E, Yéléhé-Okouma M, et al.: Intravenous single administration of amiodarone and breastfeeding. Fundam. Clin. Pharmacol. 2019; 33(3): 367–372. PubMed Abstract | Publisher Full Text

[5] 5. Halonen J, Loponen P, Järvinen O, et al.: Metoprolol versus amiodarone in the prevention of atrial fibrillation after cardiac surgery: a randomized trial. Ann. Intern. Med. 2010; 153(11): 703–709. PubMed Abstract | Publisher Full Text

[6] 6. Bigdelian H, Gharipour M, Behdad GR, et al.: The effect of amiodarone versus propanolol for prophylaxis of atrial fibrillation af-ter cabg in low ef patients.2009.

[7] 7. Kojuri J, Mahmoodi Y, Jannati M, et al.: Ability of amiodarone and propranolol alone or in combination to prevent post-coronary bypass atrial fibrillation. Cardiovasc. Ther. 2009; 27(4): 253–258. PubMed Abstract | Publisher Full Text

[8] 8. Mooss AN, Wurdeman RL, Sugimoto JT, et al.: Amiodarone versus sotalol for the treatment of atrial fibrillation after open heart surgery: the Reduction in Postoperative Cardiovascular Arrhythmic Events (REDUCE) trial. Am. Heart J. 2004; 148(4): 641–648. PubMed Abstract | Publisher Full Text

[9] 9. Nayeem-ul-hassan AMD, Wani ML, Rather HA, et al.: A comparative study on the effect of amiodarone and metaprolol for prevention of arrythmias after open heart surgery. Int. Cardiovasc. Res. J. 2013; 7(1): 1–4. PubMed Abstract

[10] 10. Sleilaty G, Madi-Jebara S, Yazigi A, et al.: Postoperative oral amiodarone versus oral bisoprolol as prophylaxis against atrial fibrillation after coronary artery bypass graft surgery: a prospective randomized trial. Int. J. Cardiol. 2009; 137(2): 116–122. PubMed Abstract | Publisher Full Text

[11] 11. Solomon AJ, Greenberg MD, Kilborn MJ, et al.: Amiodarone versus a β-blocker to prevent atrial fibrillation after cardiovascular surgery. Am. Heart J. 2001; 142(5): 811–815. PubMed Abstract | Publisher Full Text

[12] 12. Echahidi N, Pibarot P, O’Hara G, et al.: Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J. Am. Coll. Cardiol. 2008; 51(8): 793–801. Publisher Full Text

[13] 13. January CT, Wann LS, Alpert JS, et al.: 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J. Am. Coll. Cardiol. 2014; 64(21): e1–e76. PubMed Abstract | Publisher Full Text

[14] 14. Hindricks G, Potpara T, Dagres N, et al.: 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021; 42(5): 373–498. PubMed Abstract | Publisher Full Text

[15] 15. Zhu J, Wang C, Gao D, et al.: Meta-analysis of amiodarone versus beta-blocker as a prophylactic therapy against atrial fibrillation following cardiac surgery. Intern. Med. J. 2012; 42(10): 1078–1087. PubMed Abstract | Publisher Full Text

[16] 16. Fleisher LA, Fleischmann KE, Auerbach AD, et al.: 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J. Am. Coll. Cardiol. 2014; 64(22): e77–e137. PubMed Abstract | Publisher Full Text

[17] 17. Kristensen SD, Knuuti J: New ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Oxford University Press;2014; 2344–2345.

[18] 18. Bouri S, Shun-Shin MJ, Cole GD, et al.: Meta-analysis of secure randomised controlled trials of β-blockade to prevent perioperative death in non-cardiac surgery. Heart. 2014; 100(6): 456–464. PubMed Abstract | Publisher Full Text

[19] 19. Acikel S, Bozbas H, Gultekin B, et al.: Comparison of the efficacy of metoprolol and carvedilol for preventing atrial fibrillation after coronary bypass surgery. Int. J. Cardiol. 2008; 126(1): 108–113. PubMed Abstract | Publisher Full Text

[20] 20. Haghjoo M, Saravi M, Hashemi MJ, et al.: Optimal β-blocker for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery: carvedilol versus metoprolol. Heart Rhythm. 2007; 4(9): 1170–1174. PubMed Abstract | Publisher Full Text

[21] 21. Merritt JC, Niebauer M, Tarakji K, et al.: Comparison of effectiveness of carvedilol versus metoprolol or atenolol for atrial fibrillation appearing after coronary artery bypass grafting or cardiac valve operation. Am. J. Cardiol. 2003; 92(6): 735–736. Publisher Full Text

[22] 22. Wang H-S, Wang Z-W, Yin Z-T: Carvedilol for prevention of atrial fibrillation after cardiac surgery: a meta-analysis. PLoS One. 2014; 9(4): e94005. PubMed Abstract | Publisher Full Text

[23] 23. Patel A, Dunning J: Is Sotalol more effective than standard beta-blockers for the prophylaxis of atrial fibrillation during cardiac surgery. Interact. Cardiovasc. Thorac. Surg. 2005; 4(2): 147–150. PubMed Abstract | Publisher Full Text

[24] 24. Burgess DC, Kilborn MJ, Keech AC: Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur. Heart J. 2006; 27(23): 2846–2857. PubMed Abstract | Publisher Full Text

[25] 25. Evrard P, Gonzalez M, Jamart J, et al.: Prophylaxis of supraventricular and ventricular arrhythmias after coronary artery bypass grafting with low-dose sotalol. Ann. Thorac. Surg. 2000; 70(1): 151–156. PubMed Abstract | Publisher Full Text

[26] 26. Weber UK, Osswald S, Huber M, et al.: Selective versus non-selective antiarrhythmic approach for prevention of atrial fibrillation after coronary surgery: is there a need for pre-operative risk stratification? A prospective placebo-controlled study using low-dose sotalol. Eur. Heart J. 1998; 19(5): 794–800. PubMed Abstract

[27] 27. Guarnieri T, Nolan S, Gottlieb SO, et al.: Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery: the Amiodarone Reduction in Coronary Heart (ARCH) trial. J. Am. Coll. Cardiol. 1999; 34(2): 343–347. PubMed Abstract | Publisher Full Text

[28] 28. Daoud EG, Strickberger SA, Man KC, et al.: Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N. Engl. J. Med. 1997; 337(25): 1785–1791. PubMed Abstract | Publisher Full Text

[29] 29. Barnes BJ, Kirkland EA, Howard PA, et al.: Risk-stratified evaluation of amiodarone to prevent atrial fibrillation after cardiac surgery. Ann. Thorac. Surg. 2006; 82(4): 1332–1337. PubMed Abstract | Publisher Full Text

[30] 30. Auer J, Weber T, Berent R, et al.: A comparison between oral antiarrhythmic drugs in the prevention of atrial fibrillation after cardiac surgery: the pilot study of prevention of postoperative atrial fibrillation (SPPAF), a randomized, placebo-controlled trial. Am. Heart J. 2004; 147(4): 636–643. PubMed Abstract | Publisher Full Text

[31] 31. Buckley MS, Nolan PE Jr, Slack MK, et al.: Amiodarone Prophylaxis for Atrial Fibrillation After Cardiac Surgery: Meta-Analysis of Dose Response and Timing of Initiation. Pharmacotherapy. 2007; 27(3): 360–368. PubMed Abstract | Publisher Full Text

[32] 32. Chatterjee S, Sardar P, Mukherjee D, et al.: Timing and Route of Amiodarone for Prevention of Postoperative Atrial Fibrillation after Cardiac Surgery: A Network Regression Meta-analysis. Pacing Clin. Electrophysiol. 2013; 36(8): 1017–1023. PubMed Abstract | Publisher Full Text

[33] 33. Patel AA, White CM, Gillespie EL, et al.: Safety of amiodarone in the prevention of postoperative atrial fibrillation: a meta-analysis. Am. J. Health Syst. Pharm. 2006; 63(9): 829–837. PubMed Abstract | Publisher Full Text

[34] 34. Wang W, Mei YQ, Yuan XH, et al.: Clinical efficacy of epicardial application of drug-releasing hydrogels to prevent postoperative atrial fibrillation. J. Thorac. Cardiovasc. Surg. 2016; 151(1): 80–85. PubMed Abstract | Publisher Full Text

[35] 35. Tabbalat RA, Hamad NM, Alhaddad IA, et al.: Effect of colchicine on the incidence of atrial fibrillation in open heart surgery patients: END-AF trial. Am. Heart J. 2016; 178: 102–107. PubMed Abstract | Publisher Full Text

[36] 36. Yuan X, Du J, Liu Q, et al.: Defining the role of perioperative statin treatment in patients after cardiac surgery: A meta-analysis and systematic review of 20 randomized controlled trials. Int. J. Cardiol. 2017; 228: 958–966. PubMed Abstract | Publisher Full Text

[37] 37. Prasongsukarn K, Abel JG, Jamieson WE, et al.: The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: a prospective randomized trial. J. Thorac. Cardiovasc. Surg. 2005; 130(1): 93–98. PubMed Abstract | Publisher Full Text

[38] 38. Halonen J, Halonen P, Järvinen O, et al.: Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. JAMA. 2007; 297(14): 1562–1567. Publisher Full Text

[39] 39. Philip I, Berroëta C, Leblanc I: Perioperative challenges of atrial fibrillation. Curr. Opin. Anaesthesiol. 2014; 27(3): 344–352. PubMed Abstract | Publisher Full Text

[40] 40. Dieleman JM, Nierich AP, Rosseel PM, et al.: Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial. JAMA. 2012; 308(17): 1761–1767. PubMed Abstract | Publisher Full Text

[41] 41. Ho KM, Tan JA: Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery: a dose-response meta-analysis. Circulation. 2009; 119(14): 1853–1866. PubMed Abstract | Publisher Full Text

[42] 42. Piccini JP, Passman R, Turakhia M, et al.: Atrial fibrillation burden, progression, and the risk of death: a case-crossover analysis in patients with cardiac implantable electronic devices. EP Europace. 2019; 21(3): 404–413. PubMed Abstract | Publisher Full Text

[43] 43. Kaplan RM, Koehler J, Ziegler PD, et al.: Stroke risk as a function of atrial fibrillation duration and CHA2DS2-VASc score. Circulation. 2019; 140(20): 1639–1646. PubMed Abstract | Publisher Full Text

[44] 44. Cagli K, Ozeke O, Ergun K, et al.: Effect of low-dose amiodarone and magnesium combination on atrial fibrillation after coronary artery surgery. J. Card. Surg. 2006; 21(5): 458–464. PubMed Abstract | Publisher Full Text

[45] 45. White CM, Caron MF, Kalus JS, et al.: Intravenous plus oral amiodarone, atrial septal pacing, or both strategies to prevent post-cardiothoracic surgery atrial fibrillation: the Atrial Fibrillation Suppression Trial II (AFIST II). Circulation. 2003; 108(10_suppl_1): II-200–II-206. Publisher Full Text

[46] 46. Van Gelder IC, Groenveld HF, Crijns HJ, et al.: Lenient versus strict rate control in patients with atrial fibrillation. N. Engl. J. Med. 2010; 362(15): 1363–1373. PubMed Abstract | Publisher Full Text

[47] 47. Gillinov AM, Bagiella E, Moskowitz AJ, et al.: Rate control versus rhythm control for atrial fibrillation after cardiac surgery. N. Engl. J. Med. 2016; 374(20): 1911–1921. PubMed Abstract | Publisher Full Text

[48] 48. Ardaya R: Extended data for "Amiodarone versus beta-blockers for the prevention of postoperative atrial fibrillation after cardiac surgery: An updated systematic review and meta-analysis of randomised controlled trials".2022, May 13. Publisher Full Text

Amiodarone versus beta-blockers for the prevention of postoperative atrial fibrillation after cardiac surgery: An updated systematic review and meta-analysis of randomised controlled trials

Abstract

Keywords

Introduction

Objectives

Methods

Eligibility criteria

Data collection and statistical analysis

Data items

Study risk of bias assessment

Effect measures

Synthesis methods

Reporting bias assessment

Certainty assessment

Results

Table 1. Quality assessment of the included studies.

Table 2. Characteristics of studies included in the meta-analysis.

Table 3. Treatment protocol of the studies included in the meta-analysis.

AF episodes

Figure 1. Forest plot of amiodarone and beta-blocker effect on AF episodes.

AF duration

Figure 2. Forest plot of amiodarone and beta-blocker effect on AF duration.

Mean ventricular rate

Figure 3. Forest plot of amiodarone and beta-blocker effect on mean ventricular rate.

Mean length of hospital stay

Figure 4. Forest plot of amiodarone and beta-blocker effect on length of hospital stay.

Reporting biases

Certainty of evidence

Discussion

Conclusions

Data availability

Underlying data

Reporting guidelines

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Browse by related subjects

Competing Interests Policy

Stay Updated