Oesterle A, et al. - Herein, experts intended to gauge if pharmacologic prophylaxis reduced the incidence of post-operative atrial fibrillation after non-cardiac surgery. Data exhibited that a reduction could be achieved in the incidence of postoperative atrial fibrillation through pharmacologic prophylaxis with amiodarone, beta-blockers, or statins. Furthermore, a relatively low overall risk of short-term adverse events was displayed by amiodarone and statins.

Methods

• An electronic search was carried out of Ovid MEDLINE, the Cochrane central register of controlled trials database, and SCOPUS from inception to 9/7/2016.
• Prospective randomized studies were included for this analysis in which patients in sinus rhythm underwent non-cardiac surgery.
• Researchers assessed the incidence of post-operative atrial fibrillation as well as secondary safety outcomes.

Results

• A total of 21 studies including 11,608 patients were analyzed.
• The types of surgery consisted of vascular surgery (3,465 patients), thoracic surgery (2,757 patients), general surgery (2,292 patients), orthopedic surgery (1,756 patients), and other surgery (1,338 patients).
• A reduction was achieved in the post-operative atrial fibrillation due to beta-blockers (RR 0.32; 95% CI 0.11 to 0.87), amiodarone (RR 0.42; 95% CI 0.26 to 0.67), and statins (RR 0.43; 95% CI 0.27 to 0.68) compared to placebo or active controls.
• No statistically prominent effect was noted of the calcium channel blockers (RR 0.55; 95% CI 0.30 to 1.01), digoxin (RR 1.62; 95% CI 0.95 to 2.76), and magnesium (RR 0.73; 95% CI 0.23 to 2.33) on the post-operative atrial fibrillation incidence.
• Findings illustrated comparable incidence of adverse events across agents, except for increased mortality (RR 1.33; 95% CI 1.03 to 1.37) and bradycardia (RR 2.74; 95% CI 2.19 to 3.43) in subjects receiving beta-blockers.