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Original Research |

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

Conflict of interest:

Bing-Cheng Zhao declares no conflict of interest related to this work.

Tong-Yi Huang declares no conflict of interest related to this work.

Qi-Wen Deng declares no conflict of interest related to this work.

Wei-Feng Liu declares no conflict of interest related to this work.

Jian Liu declares no conflict of interest related to this work.

Wen-Tao Deng declares no conflict of interest related to this work.

Ke-Xuan Liu declares no conflict of interest related to this work.

Cai Li declares no conflict of interest related to this work.

Funding:

No funding was provided to complete the work described in this manuscript.

1Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China

2Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China

3Department of Ultrasonography, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China

Correspondence to: Cai Li, MD, PhD, Department of Anesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou 510515, China.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.08.1476
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Abstract

Background  Postoperative atrial fibrillation/flutter (POAF) is associated with significant morbidity and mortality after general thoracic surgery, but the need 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 versus 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, 11 regimens) were included. Overall, medical prophylaxis reduced the incidence of POAF (odds ratio [OR] 0.33, 95% confidence interval [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 to be the most effective agents (OR 0.12, 95% credible interval 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 bronchopulmonary system.


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