Department of Emergency Medicine,The Second Affiliated Hospital of Guangxi Medical University, Nanning - Guangxi China.
Arq Bras Cardiol. 2024 Jul;121(7):e20230856. doi: 10.36660/abc.20230856.
Atrial fibrillation (AF) is a prevalent complication associated with levosimendan; however, it remains uncertain whether there are any disparities in the effects of levosimendan on non-postoperative and postoperative AF.
This study aimed to evaluate the levosimendan effect on non-postoperative and postoperative AF by conducting a meta-analysis of randomized control trials (RCTs).
PubMed, Embase, Cochrane Library, and other databases were searched. Pairs of reviewers identified RCTs that compared levosimendan and placebo or other therapies, and the results reported AF events data. Random effects models were used (at a significance level of 5%).
Twenty-nine eligible trials comprising 6550 participants were included, eleven of which evaluated the non-postoperative AF incidence, and 18 included postoperative AF. The analysis revealed that levosimendan elevated the AF risk significantly in the non-postoperative group (OR, 1.62; 95% CI: 1.19-2.20; p=0.002) and reduced the AF incidence in the postoperative group (OR, 0.65; 95% CI: 0.44-0.96; p=0.03). AF occurrence decreased more significantly in patients who used levosimendan after cardiac surgery (OR, 0.53; 95% CI: 0.32-0.88; p=0.02) than in patients who used levosimendan before cardiac surgery (OR, 0.67; 95% CI: 0.42-1.06; p=0.09). Moreover, The AF risk was significantly elevated by levosimendan large bolus dose (bolus dose≥12 μg/kg) (OR, 1.44; 95% CI: 1.10-1.88; p=0.004) and decreased by small bolus dose of levosimendan (bolus dose<12 μg/kg) (OR, 0.64; 95% CI: 0.34-1.20; p=0.16).
Levosimendan was linked to an increased non-postoperative AF incidence. The employment of levosimendan was effective in preventing postoperative AF.
心房颤动（AF）是左西孟旦相关的常见并发症；然而，左西孟旦对非术后和术后 AF 的影响是否存在差异仍不确定。
本研究旨在通过对随机对照试验（RCT）进行荟萃分析，评估左西孟旦对非术后和术后 AF 的影响。
检索了 PubMed、Embase、Cochrane 图书馆和其他数据库。由一对评审员确定比较左西孟旦和安慰剂或其他治疗方法的 RCT，并报告 AF 事件数据。使用随机效应模型（显著性水平为 5%）。
纳入了 29 项符合条件的试验，共 6550 名参与者，其中 11 项评估了非术后 AF 发生率，18 项包括术后 AF。分析显示，左西孟旦显著增加了非术后组的 AF 风险（OR，1.62；95%CI：1.19-2.20；p=0.002），并降低了术后组的 AF 发生率（OR，0.65；95%CI：0.44-0.96；p=0.03）。心脏手术后使用左西孟旦的患者 AF 发生率降低更为显著（OR，0.53；95%CI：0.32-0.88；p=0.02），而心脏手术前使用左西孟旦的患者 AF 发生率降低不显著（OR，0.67；95%CI：0.42-1.06；p=0.09）。此外，左西孟旦大剂量（负荷剂量≥12μg/kg）显著增加了 AF 风险（OR，1.44；95%CI：1.10-1.88；p=0.004），而小剂量（负荷剂量<12μg/kg）降低了 AF 风险（OR，0.64；95%CI：0.34-1.20；p=0.16）。
左西孟旦与非术后 AF 发生率增加有关。左西孟旦的应用可有效预防术后 AF。
