Abstract 16762: Prophylaxis of Atrial Fibrillation After Non-cardiac Surgery: A Meta-analysis
Introduction: Although postoperative atrial fibrillation (AF) is common after non-cardiac surgery, there is a relative paucity of data regarding effective pharmacologic prophylaxis.
Methods: This was a meta-analysis of randomized controlled trials and prospective cohort studies investigating pharmacologic therapy to prevent postoperative AF after non-cardiac surgery. The primary endpoint was incidence of postoperative AF and secondary endpoint was incidence of adverse events due to medical therapy.
Results: Of 14,225 studies reviewed, 18 were selected for analysis, representing 11,111 patients. Types of surgery performed included vascular surgery (3,465 patients, 31%), thoracic surgery (2,260 patients, 20%), general surgery (2,292 patients, 20%), orthopedic surgery (1,756 patients, 16%), and other surgery (1,338 patients, 12%). The overall incidence of postoperative AF was 5.9%; 17.1% after thoracic surgery, and 3.1% after non-thoracic surgery. Pharmacologic prophylaxis reduced the incidence of AF compared to control overall (OR 0.56, 95% confidence interval [CI] 0.39-0.79) driven by calcium channel blockers (OR 0.47, 95% CI 0.23-0.95) and amiodarone (OR 0.36, 95% CI 0.19-0.68) (see Figure). Magnesium (OR 0.69, 95% CI 0.18-2.64) showed no efficacy at prophylaxis. There was a trend towards benefit in patients receiving beta-blockers (OR 0.36, 95% CI 0.11-1.24), and to increased risk in those receiving digoxin (OR 1.86, 95% CI 0.99-3.52). Incidence of adverse events was comparable across agents, except for a signal for increased risk for hypotension, bradycardia, and stroke in patients receiving beta-blockers. The I2 is 69%, indicating significant heterogeneity amongst the studies.
Conclusion: Pharmacologic prophylaxis—particularly with calcium channel blockers or amiodarone—reduces incidence of postoperative AF after non-cardiac surgery, while digoxin may increase risk.
Author Disclosures: A. Oesterle: None. B. Weber: None. N. Choudhry: None. J. Singh: Research Grant; Significant; St. Jude. Consultant/Advisory Board; Modest; St. Jude, Biotronik, Boston Scientific, Sorin, Respicardia, CardioInsight, Impulse Dynamics, MDT. G. Upadhyay: None.
- © 2016 by American Heart Association, Inc.