Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic review and meta-analysis

Postoperative atrial fibrillation (POAF) is a potentially lethal and morbid complication after open heart surgery. This systematic review and meta-analysis aimed to investigate metoprolol compared with other treatments for prophylaxis against POAF. We searched CENTRAL, MEDLINE, EMBASE and trial regi...

Full description

Saved in:

Bibliographic Details
Published in:	BMJ open Vol. 10; no. 10; p. e038364
Main Authors:	Norhayati, Mohd Noor, Shaiful Bahari, Ismail, Zaharah, Sulaiman, Nik Hazlina, Nik Hussain, Mohammad Aimanazrul, Zainuddin, Irfan, Muhammad
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 31-10-2020 BMJ Publishing Group
Series:	Original research
Subjects:	Age Amiodarone - therapeutic use Anti-Arrhythmia Agents - therapeutic use Atrial Fibrillation - epidemiology Atrial Fibrillation - etiology Atrial Fibrillation - prevention & control Bias Cardiac arrhythmia Cardiac Surgical Procedures - adverse effects Cardiovascular Medicine Disease prevention Drug dosages Heart attacks Heart surgery Humans Hypotension Intervention Meta-analysis Metoprolol - therapeutic use Patients Postoperative Complications - drug therapy Postoperative Complications - prevention & control Postoperative period Systematic review cardiothoracic surgery cardiac surgery cardiology myocardial infarction
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Postoperative atrial fibrillation (POAF) is a potentially lethal and morbid complication after open heart surgery. This systematic review and meta-analysis aimed to investigate metoprolol compared with other treatments for prophylaxis against POAF. We searched CENTRAL, MEDLINE, EMBASE and trial registries for randomised controlled trials that evaluated metoprolol for preventing the occurrence of POAF after surgery against other treatments or placebo. Random-effects model was used for estimating the risk ratios (RRs) and mean differences with 95% CIs. Nine trials involving 1570 patients showed metoprolol reduced POAF compared with placebo (416 patients; RR 0.46, 95% CI 0.33 to 0.66; I²=21%; risk difference (RD) -0.19, 95% CI -0.28 to -0.10). However, metoprolol increased the risk of POAF compared with carvedilol (159 patients; RR 1.59, 95% CI 1.20 to 2.12; I²=4%; RD 0.13, 95% CI 0.06 to 0.20). There was no difference when compared with sotalol or amiodarone. The occurrence of cardiovascular conditions after drugs administration or death between the groups was not different. The overall quality of evidence was moderate to high. Subgroup analysis and funnel plot were not performed. Metoprolol is effective in preventing POAF compared with placebo and showed no difference with class III antiarrhythmic drugs. Death and thromboembolism are associated with open heart surgery, but not significant in relation to the use of metoprolol. CRD42019131585.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3
ISSN:	2044-6055 2044-6055
DOI:	10.1136/bmjopen-2020-038364