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Original Research: Cardiovascular Disease |

Prophylaxis Against Atrial Fibrillation After General Thoracic Surgery: Trial Sequential Analysis and Network Meta-Analysis

Bing-Cheng Zhao, MD; Tong-Yi Huang, MD; Qi-Wen Deng, MD; Wei-Feng Liu, MD, PhD; Jian Liu, MD; Wen-Tao Deng, MD; Ke-Xuan Liu, MD, PhD; Cai Li, MD, PhD
Author and Funding Information

Drs Zhao, Huang, Q-W. Deng, and W-F. Liu contributed equally to this article.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aDepartment of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China

bDepartment of Anesthesiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

cDepartment of Ultrasonography, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

CORRESPONDENCE TO: Cai Li, MD, PhD, Department of Anesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou 510515, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(1):149-159. doi:10.1016/j.chest.2016.08.1476
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Background  Postoperative atrial fibrillation/flutter (POAF) is associated with significant morbidity and mortality after general thoracic surgery, but the need for and the best agent for prophylaxis remains obscure.

Methods  A systematic literature search was performed to identify randomized controlled trials that compared regimens for POAF prophylaxis after general thoracic surgery. Random-effects meta-analyses with trial sequential analyses were performed to compare the effects of medical prophylaxis vs placebo/usual care. The risk of POAF among patients receiving various prophylactic regimens was subjected to Bayesian network meta-analysis.

Results  Twenty-two trials (2,891 patients and 11 regimens) were included. Overall, medical prophylaxis reduced the incidence of POAF (OR, 0.33; 95% CI, 0.22-0.49) but not short-term mortality (OR, 0.85; 95% CI, 0.41-1.73). There was no significant difference in patient withdrawal due to adverse events (OR, 1.67; 95% CI, 0.67-4.16). Trial sequential analysis showed that as of 2012, sufficient evidence had accrued in support of the effectiveness of medical prophylaxis in reducing POAF after general thoracic surgery. In network meta-analysis, β-blockers, angiotensin-converting enzyme inhibitors, amiodarone, magnesium, and calcium channel blockers significantly reduced the risk of POAF compared with placebo/usual care. β-Blockers had the highest probability of being the most effective agents (OR, 0.12; 95% credible interval [CrI], 0.05-0.27; probability of being best, 77.7%; number needed to treat, 5.2).

Conclusions  The current literature supports the effectiveness and tolerability of medical prophylaxis and the superiority of β-blockers in preventing POAF after general thoracic surgery. β-Blockers are recommended, taking into consideration the status of the bronchopulmonary system.

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