Background: Optimum prophylaxis for post‐operative atrial fbrillation (AF) in cardiac surgery patients is controversial. We aimed to compare the utility of amiodarone (A) versus beta blockers (BB) in decreasing the postoperative incidence of AF. Methods: Online search of PubMed, MEDLINE, EMBASE, SCOPUS, COCHRANE, and GOOGLE SCHOLAR databases was performed (1988 ‐ Present); key bibliographies were reviewed. Studies comparing use of perioperative A to BB in cardiac surgery patients were included. Relative risks with the corresponding 95% confdence intervals (CI) by random and fxed effects models of pooled data were calculated. Study quality was assessed using STROBE criteria. The primary outcome was postoperative incidence of AF. Secondary outcomes included onset, duration of AF and ventricular response rate (VRR). Results: Search strategy yielded 136 studies, 8 randomized controlled trials met our selection criteria. A total of 1457 patients underwent either coronary artery bypass graft (n= 1397), valvular surgery (n=24) or both (n=36). There was no signifcant difference between the two groups in age, sex, smoking status, number of cardiac vessels involved or co‐morbities. Median age was 62 yrs. M/F ratio was 2.6/1. 722 patients received peri‐operative A and 735 patients received BB mostly metoprolol. Metaanalysis of included data showed signifcantly less incidence of AF in the A group (RR 0.75; 95% CI:0.58‐0.97, p=0.029). The onset of AF was delayed in the BB group (SMD 0.43; CI:0.08‐0.76, p=0.014). There was no signifcant difference between the groups in duration of AF (SMD ‐0.28; 95% CI:‐1.01 to 0.46, p=0.45) or VRR (SMD 0.58; 95% CI:‐0.51‐1.68, p=0.29). Conclusions: Peri‐operative use of amiodarone in cardiac surgery patients is associated with lower yet earlier incidence of AF compared to BB. Randomized clinical trials are needed to validate this fnding and further investigate independent risk factors associated with postoperative AF.
Kirolos, I., Derbal, O., Gadde, R., Yakoub, D., Alfonso, C., Chaparro, S., … Cohen, M. (2017). PERIOPERATIVE ADMINISTRATION OF AMIODARONE OR BETA BLOCKERS IN CARDIAC SURGERY: WHICH IS MORE EFFECTIVE IN REDUCING POSTOPERATIVE ATRIAL FIBRILLATION? Journal of the American College of Cardiology, 69(11), 459. https://doi.org/10.1016/s0735-1097(17)33848-2