Masuda Yoshio, Luo Hai Dong, Kang Giap Swee, Teoh Kristine Leok-Kheng, Kofidis Theodoros
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Cardiac, Thoracic & Vascular Surgery, National University Heart Centre Singapore, Singapore.
JTCVS Open. 2020 Jul 16;3:66-85. doi: 10.1016/j.xjon.2020.07.004. eCollection 2020 Sep.
Postoperative atrial fibrillation (POAF) is a common problem of cardiac surgery. Beta-blockers are recognized as effective prophylactic agents available for POAF management. To better understand its effect on isolated atrial fibrillation after cardiac surgery, a meta-analysis was conducted.
Randomized controlled trials (RCTs) were searched and filtered by comparing the efficacy of beta-blockers and control users in isolated POAF for cardiac surgery. Seventeen RCTs were identified and analyzed by typical meta-analysis methods. The search was performed from inception to May 31, 2020. Subgroup analyses were conducted for type of surgery and beta-blocker, starting time and route of administration of beta-blocker, and dosage of intravenous landiolol hydrochloride.
Beta-blockers were effective in reducing isolated POAF risk (risk ratio [RR], 0.52 [0.41, 0.66], = .31, I = 12%). In subgroup analyses, beta-blocker administration during postoperative period (RR, 0.43 [0.29, 0.62], = .84, I = 0%) and on-pump coronary artery bypass graft (RR, 0.34 [0.04, 3.15], = .56, I = 0%) had lowest risk of isolated POAF incidence. Intravenous landiolol hydrochloride at 2 μg/kg/min also had low risk of isolated POAF occurrence.
Beta-blocker treatment helps to reduce isolated atrial fibrillation incidence after cardiac surgery. Our subgroup analyses also reveal postoperative beta-blocker administration after on-pump coronary artery bypass graft surgery is most effective in reducing isolated POAF risk. Intravenous landiolol hydrochloride at a dosage of 2 μg/kg/min has also displayed favorable results. Further trials may be required to explore these factors.
术后心房颤动（POAF）是心脏手术常见的问题。β受体阻滞剂被认为是可用于POAF管理的有效预防药物。为了更好地了解其对心脏手术后孤立性心房颤动的影响，进行了一项荟萃分析。
通过比较β受体阻滞剂与对照组在心脏手术孤立性POAF中的疗效，检索并筛选随机对照试验（RCT）。通过典型的荟萃分析方法确定并分析了17项RCT。检索时间从开始至2020年5月31日。对手术类型和β受体阻滞剂、β受体阻滞剂的起始时间和给药途径以及静脉注射盐酸兰地洛尔的剂量进行亚组分析。
β受体阻滞剂可有效降低孤立性POAF风险（风险比[RR]，0.52[0.41，0.66]，P = 0.31，I² = 12%）。在亚组分析中，术后使用β受体阻滞剂（RR，0.43[0.29，0.62]，P = 0.84，I² = 0%）和体外循环冠状动脉搭桥术（RR，0.34[0.04，3.15]，P = 0.56，I² = 0%）时孤立性POAF发生率风险最低。静脉注射2μg/kg/min的盐酸兰地洛尔时，孤立性POAF发生风险也较低。
β受体阻滞剂治疗有助于降低心脏手术后孤立性心房颤动的发生率。我们的亚组分析还显示，体外循环冠状动脉搭桥术后给予β受体阻滞剂对降低孤立性POAF风险最有效。静脉注射剂量为2μg/kg/min的盐酸兰地洛尔也显示出良好的效果。可能需要进一步试验来探究这些因素。
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