Abstract
Background
Although postoperative atrial fibrillation is common after noncardiac surgery, there
is a paucity of data regarding prophylaxis. We sought to determine whether pharmacologic
prophylaxis reduces the incidence of postoperative atrial fibrillation after noncardiac
surgery.
Methods
We performed an electronic search of Ovid MEDLINE, the Cochrane central register of
controlled trials database, and SCOPUS from inception to September 7, 2016 and included
prospective randomized studies in which patients in sinus rhythm underwent noncardiac
surgery and examined the incidence of postoperative atrial fibrillation as well as
secondary safety outcomes.
Results
Twenty-one studies including 11,608 patients were included. Types of surgery included
vascular surgery (3465 patients), thoracic surgery (2757 patients), general surgery
(2292 patients), orthopedic surgery (1756 patients), and other surgery (1338 patients).
Beta-blockers (relative risk [RR] 0.32; 95% confidence interval [CI], 0.11-0.87),
amiodarone (RR 0.42; 95% CI, 0.26 to 0.67), and statins (RR 0.43; 95% CI, 0.27 to
0.68) reduced postoperative atrial fibrillation compared with placebo or active controls.
Calcium channel blockers (RR 0.55; 95% CI, 0.30 to 1.01), digoxin (RR 1.62; 95% CI,
0.95 to 2.76), and magnesium (RR 0.73; 95% CI, 0.23 to 2.33) had no statistically
significant effect on postoperative atrial fibrillation incidence. The incidence of
adverse events was comparable across agents, except for increased mortality (RR 1.33;
95% CI, 1.03 to 1.37) and bradycardia (RR 2.74; 95% CI, 2.19 to 3.43) in patients
receiving beta-blockers.
Conclusions
Pharmacologic prophylaxis with amiodarone, beta-blockers, or statins reduces the incidence
of postoperative atrial fibrillation after noncardiac surgery. Amiodarone and statins
have a relatively low overall risk of short-term adverse events.
Keywords
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Article info
Publication history
Published online: February 21, 2018
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing the manuscript.
Identification
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© 2018 Elsevier Inc. All rights reserved.
