Interventions for preventing post‐operative atrial fibrillation in patients undergoing heart surgery

Background Atrial fibrillation is a common post‐operative complication of cardiac surgery and is associated with an increased risk of post‐operative stroke, increased length of intensive care unit and hospital stays, healthcare costs and mortality. Numerous trials have evaluated various pharmacological and non‐pharmacological prophylactic interventions for their efficacy in preventing post‐operative atrial fibrillation. We conducted an update to a 2004 Cochrane systematic review and meta‐analysis of the literature to gain a better understanding of the effectiveness of these interventions. Objectives The primary objective was to assess the effects of pharmacological and non‐pharmacological interventions for preventing post‐operative atrial fibrillation or supraventricular tachycardia after cardiac surgery. Secondary objectives were to determine the effects on post‐operative stroke or cerebrovascular accident, mortality, cardiovascular mortality, length of hospital stay and cost of treatment during the hospital stay. Search methods We searched the Cochrane Central Register of ControlLed Trials (CENTRAL) (Issue 8, 2011), MEDLINE (from 1946 to July 2011), EMBASE (from 1974 to July 2011) and CINAHL (from 1981 to July 2011). Selection criteria We selected randomized controlled trials (RCTs) that included adult patients undergoing cardiac surgery who were allocated to pharmacological or non‐pharmacological interventions for the prevention of post‐operative atrial fibrillation or supraventricular tachycardia, except digoxin, potassium (K+), or steroids. Data collection and analysis Two review authors independently ed study data and assessed trial quality. Main results One hundred and eighteen studies with 138 treatment groups and 17,364 participants were included in this review. Fifty‐seven of these studies were included in the original version of this review while 61 were added, including 27 on interventions that were not considered in the original version. Interventions included amiodarone, beta‐blockers, sotalol, magnesium, atrial pacing and posterior pericardiotomy. Each of the studied interventions significantly reduced the rate of post‐operative atrial fibrillation after cardiac surgery compared with a control. Beta‐blockers (odds ratio (OR) 0.33; 95% confidence interval) CI 0.26 to 0.43; I2 = 55%) and sotalol (OR 0.34; 95% CI 0.26 to 0.43; I2 = 3%) appear to have similar efficacy while magnesium's efficacy (OR 0.55; 95% CI 0.41 to 0.73; I2 = 51%) may be sli