Center for Arrhythmia Care, The University of Chicago, Ill.
Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
Am J Med. 2018 Jul;131(7):795-804.e5. doi: 10.1016/j.amjmed.2018.01.032. Epub 2018 Feb 21.
Although postoperative atrial fibrillation is common after noncardiac surgery, there is a paucity of data regarding prophylaxis. We sought to determine whether pharmacologic prophylaxis reduces the incidence of postoperative atrial fibrillation after noncardiac surgery.
We performed an electronic search of Ovid MEDLINE, the Cochrane central register of controlled trials database, and SCOPUS from inception to September 7, 2016 and included prospective randomized studies in which patients in sinus rhythm underwent noncardiac surgery and examined the incidence of postoperative atrial fibrillation as well as secondary safety outcomes.
Twenty-one studies including 11,608 patients were included. Types of surgery included vascular surgery (3465 patients), thoracic surgery (2757 patients), general surgery (2292 patients), orthopedic surgery (1756 patients), and other surgery (1338 patients). Beta-blockers (relative risk [RR] 0.32; 95% confidence interval [CI], 0.11-0.87), amiodarone (RR 0.42; 95% CI, 0.26 to 0.67), and statins (RR 0.43; 95% CI, 0.27 to 0.68) reduced postoperative atrial fibrillation compared with placebo or active controls. 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) had no statistically significant effect on postoperative atrial fibrillation incidence. The incidence of adverse events was comparable 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 patients receiving beta-blockers.
Pharmacologic prophylaxis with amiodarone, beta-blockers, or statins reduces the incidence of postoperative atrial fibrillation after noncardiac surgery. Amiodarone and statins have a relatively low overall risk of short-term adverse events.
尽管非心脏手术后常发生心房颤动，但有关预防措施的数据却很少。我们旨在确定药物预防是否能降低非心脏手术后心房颤动的发生率。
我们对 Ovid MEDLINE、Cochrane 对照试验中心注册数据库和 SCOPUS 进行了电子检索，检索时间从建库至 2016 年 9 月 7 日，纳入窦性心律患者接受非心脏手术，并观察术后心房颤动发生率和次要安全性结局的前瞻性随机研究。
共纳入 21 项研究，包括 11608 例患者。手术类型包括血管外科手术（3465 例）、胸外科手术（2757 例）、普通外科手术（2292 例）、矫形外科手术（1756 例）和其他手术（1338 例）。β受体阻滞剂（RR 0.32；95%CI，0.11-0.87）、胺碘酮（RR 0.42；95%CI，0.26 至 0.67）和他汀类药物（RR 0.43；95%CI，0.27 至 0.68）与安慰剂或活性对照相比，可降低术后心房颤动的发生率。钙通道阻滞剂（RR 0.55；95%CI，0.30 至 1.01）、地高辛（RR 1.62；95%CI，0.95 至 2.76）和镁（RR 0.73；95%CI，0.23 至 2.33）对术后心房颤动发生率无统计学意义。除接受β受体阻滞剂的患者死亡率增加（RR 1.33；95%CI，1.03 至 1.37）和心动过缓（RR 2.74；95%CI，2.19 至 3.43）外，各药物的不良事件发生率无差异。
胺碘酮、β受体阻滞剂或他汀类药物预防可降低非心脏手术后心房颤动的发生率。胺碘酮和他汀类药物短期不良事件总风险相对较低。
