Intervention is favoured in the prevention of post-operative atrial fibrillation and in the reduction of patient length of stay

Crystal E, Garfinkle MS, Connolly S, Ginger T, Sleik K, Yusuf S

Published Online:

January 21, 2009

Post-operative atrial fibrillation is a common complication of cardiac surgery and has been associated with an increased incidence of other complication. To better understand the role of various treatment protocols, a meta-analytic review was performed. The various treatments had a decidedly positive effect in reducing stroke and length of stay and a slightly positive effect in reducing cost of hospitalisation. Of all the interventions tested, beta-blocker usage led to the least occurrences of post-operative atrial fibrillation.

Abstract (click to read)

Background:

Post-operative atrial fibrillation is a common complication of cardiac surgery and has been associated with increased incidence of other complications including post-operative stroke, increased hospital length of stay and increased cost of hospitalisation. Prevention of atrial fibrillation is a reasonable clinical goal and, consequently, many randomised trials have evaluated the effectiveness of pharmacological and non-pharmacological interventions. We systematically reviewed the literature and prepared meta-analyses to better understand the role and effects of various prophylactic therapies against post-operative atrial fibrillation.

Objectives:

To assess the effects of pharmacological and non-pharmacological interventions for preventing post-cardiac surgery atrial fibrillation.

Search strategy:

We searched CENTRAL, MEDLINE, EMBASE and CINAHL from earliest achievable date to June 2003. We hand searched references from reports and earlier reviews. We searched abstract books and CD-ROMs from annual scientific meetings of American College of Cardiology, American Heart Association, North American Society of Pacing and Electrophysiology and European Heart Organization between 1997-2003. No language restrictions were applied.

Selection criteria:

Randomised controlled trials comparing pharmacological interventions or non-pharmacological interventions with control treatment, placebo or usual care for the prevention of post-operative atrial fibrillation in post-coronary artery bypass grafting or combined CABG and valvular surgery.

Data collection and analysis:

Two reviewers assessed trial quality and extracted data. Study authors were contacted for additional information.

Main results:

Fifty eight studies were included with a total of 8565 participants. Interventions included were amiodarone, beta blockers, sotalol and pacing. Results favoured treatment for post-operative atrial fibrillation. The data for stroke favoured treatment by a non-significant effect size of 0.81, 95% confidence interval 0.51 to 1.28. Similarly, a positive indication for length of stay was derived but it too was not significant with a weighted mean difference of -0.66, 95% confidence interval -0.95 to -0.37. A positive result for cost of hospitalisation in favour of treatment was achieved, but the statistic is not significant due to low power and large standard deviations: a weighted mean difference of -2717, 95% confidence interval 7518 to 2084. Beta-blockers had the greatest magnitude of effect across 28 trials (4074 patients) with an odds ratio (random) of 0.35, 95% confidence interval 0.26 to 0.49. Across all treatment, the odds ratio favoured treatment with a ratio (random) of 0.43, 95% confidence interval 0.37 to 0.51.

Authors' conclusions:

Intervention is favoured across the three pharmacological interventions studied and the one non-pharmacological intervention, pacing. The length of stay data favoured treatment (-0.66, 95% confidence interval -0.95 to -0.37).

This record should be cited as:

Crystal E, Garfinkle MS, Connolly S, Ginger T, Sleik K, Yusuf S. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD003611. DOI: 10.1002/14651858.CD003611.pub2

Assessed as up to date:

August 1, 2004

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Primary Review Group:

Heart Group

Health topics:

Heart & circulation > Heart surgery > Other

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Intervention is favoured in the prevention of post-operative atrial fibrillation and in the reduction of patient length of stay

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