Burgess David C, Kilborn Michael J, Keech Anthony C
National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Level 5, Building F, 88 Mallett Street, Camperdown 2050, Sydney, NSW, Australia.
Eur Heart J. 2006 Dec;27(23):2846-57. doi: 10.1093/eurheartj/ehl272. Epub 2006 Oct 2.
Atrial fibrillation (AF) is the most common complication after cardiac surgery. We aimed to evaluate, by meta-analysis, all randomized trials testing interventions for preventing AF.
Ninety-four trials of prevention of post-operative AF were identified, by standard search methods, and analysed by standard meta-analysis techniques. All five commonly tested interventions, beta-blockers (BBs), sotalol, amiodarone, magnesium, and atrial pacing, were effective in preventing AF. The odds ratio (OR) for the effect of BB on the incidence of AF was 0.36 (95% CI 0.28-0.47, P<0.001), but after trials confounded by post-operative non-study BB withdrawal were excluded was 0.69 (95% CI 0.54-0.87, P=0.002). Sotalol reduced AF, compared with placebo (OR 0.34, 95% CI 0.26-0.45, P<0.001) and compared with conventional BB (OR 0.42, 95% CI 0.26-0.65, P<0.001). Amiodarone reduced AF (OR 0.48, 95% CI 0.40-0.57, P<0.001). Magnesium (Mg) also had an effect (OR 0.57 95% CI 0.42-0.77) but there was significant heterogeneity (P<0.001), partly explained by concomitant BB. The effect of Mg with BB was less (OR 0.83, 95% CI 0.60-1.16). Pacing reduced AF (OR 0.60, 95% CI 0.47-0.77, P<0.001), despite wide variations in techniques. Only amiodarone and pacing significantly reduced length of stay, average -0.60 days (95% CI -0.92 to -0.29) and -1.3 days (95% CI -2.55 to -0.08), respectively. Collectively, all treatments analysed together reduced stroke (OR 0.63, 95% CI 0.41-0.98). Amiodarone was the only intervention that alone significantly reduced stroke rate (OR 0.54, 95% CI 0.30-0.95).
All five interventions reduced the incidence of AF, though the effect of BBs is less than previously thought. The significant reductions in length of stay and stroke in meta-analysis suggest that there are worthwhile benefits from aggressive prevention. Larger studies to confirm these clinical benefits and evaluate their cost-effectiveness would be worthwhile.
心房颤动（AF）是心脏手术后最常见的并发症。我们旨在通过荟萃分析评估所有测试预防AF干预措施的随机试验。
通过标准检索方法确定了94项预防术后AF的试验，并采用标准荟萃分析技术进行分析。所有五种常用的干预措施，β受体阻滞剂（BBs）、索他洛尔、胺碘酮、镁和心房起搏，均对预防AF有效。BB对AF发生率影响的比值比（OR）为0.36（95%可信区间0.28 - 0.47，P<0.001），但排除术后非研究性BB停药导致混淆的试验后为0.69（95%可信区间0.54 - 0.87，P = 0.002）。与安慰剂相比，索他洛尔降低了AF的发生率（OR 0.34，95%可信区间0.26 - 0.45，P<0.001），与传统BB相比（OR 0.42，95%可信区间0.26 - 0.65，P<0.001）也是如此。胺碘酮降低了AF的发生率（OR 0.48，95%可信区间0.40 - 0.57，P<0.001）。镁（Mg）也有作用（OR 0.57，95%可信区间0.42 - 0.77），但存在显著异质性（P<0.001），部分原因是同时使用BB。Mg与BB联合使用时效果较小（OR 0.83，95%可信区间0.60 - 1.16）。尽管技术差异很大，但起搏降低了AF的发生率（OR 0.60，95%可信区间0.47 - 0.77，P<0.001）。只有胺碘酮和起搏显著缩短了住院时间，平均分别缩短了 - 0.60天（95%可信区间 - 0.92至 - 0.29）和 - 1.3天（95%可信区间 - 2.55至 - 0.08）。总体而言，所有分析的治疗方法共同降低了中风发生率（OR 0.63，95%可信区间0.41 - 0.98）。胺碘酮是唯一能单独显著降低中风发生率的干预措施（OR 0.54，95%可信区间0.30 - 0.95）。
所有五种干预措施均降低了AF的发生率，尽管BBs的效果低于先前的认识。荟萃分析中住院时间和中风发生率的显著降低表明积极预防有显著益处。进行更大规模的研究以证实这些临床益处并评估其成本效益将是值得的。
