Author + information
- Irene Kirolos,
- Ouassim Derbal,
- Rahul Gadde,
- Danny Yakoub,
- Carlos Alfonso,
- Sandra Chaparro,
- Tomas Salerno and
- Mauricio Cohen
Background: Optimum prophylaxis for post-operative atrial fibrillation (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% confidence intervals (CI) by random and fixed 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 significant 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 significantly 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 significant 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 finding and further investigate independent risk factors associated with post-operative AF.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation and VT: Specific Situations and Newer Outcome Measures
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1190-107
- 2017 American College of Cardiology Foundation