Combination prophylactic amiodarone with beta-blockers versus beta-blockers in atrial fibrillation after cardiac surgery: A systematic-review and meta-analysis

Authors

Edgar Theodore Polintan, Department of Internal Medicine, SSM-Health St. Mary's Hospital, St. Louis, MO, USA. Electronic address: edgartheodore.polintan@ssmhealth.com.
Reejeen Monsalve, College of Medicine, Our Lady of Fatima University, Valenzuela City, Philippines.
Rajiv Hans Menghrajani, Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA.
Kym Yves Sirilan, Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA.
Sandeep Samethadka Nayak, Division of Hospital Medicine, Department of Internal Medicine, Yale New Haven Bridgeport Hospital, Bridgeport, CT, USA.
Peter Abdelmaseeh, Department of Medicine, Christiana Care Hospital, Delaware, USA.
Gabriel Patarroyo-Aponte, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Kevin Bryan Lo, Department of Medicine, Einstein Medical Center, Sidney Kimmel College of Medicine Thomas Jefferson University, Philadelphia, PA, USA.
Sourbha S. Dani, Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA.

Document Type

Article

Publication Title

Heart & lung : the journal of critical care

Abstract

BACKGROUND: Guideline recommendations regarding the preferred preventive measures for postoperative atrial fibrillation (POAF) are unclear, nor have we found any review articles addressing the combination of amiodarone and beta-blockers for the prevention of POAF. OBJECTIVES: To investigate the efficacy and safety of combination beta-blockers and amiodarone in the prevention of POAF while also comparing the use of amiodarone and beta-blockers individually. METHODS: We used Pubmed as the primary resource. POAF incidence was the primary outcome of this study. The secondary outcomes were hospital length of stay (LOS), ICU LOS, treatment-related drug discontinuation (TRDD), and mortality. The random-effects model assessed all pooled outcomes with 95% confidence intervals. Statistical significance was set at p≤0.05. RESULTS: The amiodarone subgroup of POAF incidence saw a Risk Ratio (RR) of 0.81 [0.63, 1.06], p=0.12, while the combination subgroup resulted in a RR of 0.63 [0.49, 0.80], p <0.001. TRDD for the amiodarone subgroup resulted in a RR of 0.68 [0.25, 1.82], p=0.44, while the combination subgroup saw a RR of 0.84 [0.57, 1.23], p=0.36. For mortality, the amiodarone subgroup resulted in a RR of 0.97 [0.48, 1.98], p=0.93, while the combination subgroup resulted in a RR of 1.04 [0.27, 4.05], p=0.96. Both hospital and ICU LOS saw no significant difference between treatment arms for both the combination subgroup and amiodarone alone. Except for the incidence of postoperative atrial fibrillation (POAF) in the combination prophylaxis group, most of the measured outcomes did not meet the optimized information size (OIS) that was estimated. CONCLUSION: Combination prophylaxis with amiodarone and beta-blockers significantly lowered risks of POAF incidence in comparison to beta-blockers alone while also having comparative mortality and TRDD outcomes.

First Page

256

Last Page

263

DOI

10.1016/j.hrtlng.2023.08.006

Publication Date

1-1-2023

Recommended Citation

Polintan, Edgar Theodore; Monsalve, Reejeen; Menghrajani, Rajiv Hans; Sirilan, Kym Yves; Nayak, Sandeep Samethadka; Abdelmaseeh, Peter; Patarroyo-Aponte, Gabriel; Lo, Kevin Bryan; and Dani, Sourbha S., "Combination prophylactic amiodarone with beta-blockers versus beta-blockers in atrial fibrillation after cardiac surgery: A systematic-review and meta-analysis" (2023). Systematic Reviews. 12.
https://scholar.bridgeporthospital.org/descriptive_study/12

Identifier

37619317 (pubmed); 10.1016/j.hrtlng.2023.08.006 (doi); S0147-9563(23)00215-7 (pii)