scholarly journals Preoperative Antihypertensive Medication in Relation to Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-12
Author(s):  
Ai-Guo Zhou ◽  
Xian-Xue Wang ◽  
Dao-Bo Pan ◽  
An-ji Chen ◽  
Xiong-fei Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Ace Inhibitors ◽  
Calcium Antagonists ◽  
Antihypertensive Medication ◽  
Meta Analysis ◽  
Postoperative Atrial Fibrillation ◽  
Cochrane Library ◽  
Blocking Agents ◽  
Beta Blocking

Background. We undertake a systematic review and meta-analysis to evaluate the effect of preoperative hypertension and preoperative antihypertensive medication to postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to March 2016) for eligible studies. The outcomes were the effects of preoperative hypertension, preoperative calcium antagonists regimen, preoperative ACE inhibitors regimen, and preoperative beta blocking agents regimen with POAF. We calculated pooled risk ratios (OR) and 95% CIs using random- or fixed-effects models. Results. Twenty-five trials involving 130087 patients were listed. Meta-analysis showed that the number of preoperative hypertension patients in POAF group was significantly higher (P<0.05), while we found that there are no significant differences between two groups in Asia patients by subgroup analysis, which is in contrast to other outcomes. Compared with the Non-POAF group, the number of patients who used calcium antagonists and ACE inhibitors preoperatively in POAF group was significantly higher (P<0.05). And we found that there were no significant differences between two groups of preoperative beta blocking agents used (P=0.08). Conclusions. Preoperative hypertension and preoperative antihypertensive medication in patients undergoing cardiac operations seem to be associated with higher risk of POAF.

Abstract 4102: Preoperative Angiotensin Blocking Drug Therapy Does Not Reduce Atrial Fibrillation After Cardiac Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Florian Rader ◽  
Eugene H Blackstone
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Drug Therapy ◽  
Propensity Score ◽  
Ace Inhibitors ◽  
Postoperative Atrial Fibrillation ◽  
Consecutive Series ◽  
Blocking Drug ◽  
Valvular Surgery ◽  
Co Morbidity

Introduction: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. Angiotensin blocking drug therapy (ABDT) with Angiotensin converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs) has been shown to have anti-arrhythmic effects in animal models. However, data from small observational studies of ABDT use in patients undergoing cardiac surgery had discordant results and did not sufficiently adjust for selection bias. Therefore, we performed the largest study to date examining the association between preoperative use of ABDT and postoperative atrial fibrillation. Methods and Results: A consecutive series of 10,552 patients underwent coronary artery bypass graft (CABG) surgery with or without valvular surgery at Cleveland Clinic between 1997 through 2002. Of these 4,795 (45%) patients were on ABDT within 30 days prior to surgery and 3,633 (34%) patients developed POAF prior to discharge. Without adjusting for patient co-morbidities, ABDT had an Odds Ratio (OR) of 1.13 (95% Confidence Interval (CI) 1.05–1.25, p<0.01). A propensity score matched sample was developed, adjusting for 68 potential confounders. In the 6874 matched patients, who had a well balanced co-morbidity profile, ABDT was not associated with POAF (OR 1.03, CI 0.93–1.12, p=0.67). A subsequent propensity score matched analysis of 3227 patients, who underwent isolated valvular surgery in the same timeframe, also demonstrated ineffectiveness of preoperative ABDT (OR 0.91, CI 0.74 –1.09, p=0.33), irrespective of valve location. Stratified analysis by linear propensity score quintiles and propensity-adjusted logistic multivariable regression analysis of all patients in the CABG and the valvular surgery cohort confirmed these findings. Conclusions: In this large observational study preoperative use of ACE inhibitors or ARBs did not reduce postoperative occurrence of atrial fibrillation in patients undergoing cardiac surgery. Although withdrawal from ABDT prior to surgery is common practice and could account for this result, we cannot recommend such therapy for primary prophylaxis without larger randomized controlled trials.

scholarly journals Pharmacological interventions for preventing post-operative atrial fibrillation in patients undergoing cardiac surgery: a network meta-analysis protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018544 ◽  
Author(s):  
Xiaoqin Wang ◽  
Liang Yao ◽  
Long Ge ◽  
Lun Li ◽  
Fuxiang Liang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Systematic Reviews ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Trial Sequential Analysis ◽  
Pharmacological Interventions ◽  
Patient Consent ◽  
Meta Analyses

IntroductionPostoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, and randomised clinical trials (RCTs) and systematic reviews have been conducted to compare and evaluate different pharmacological interventions for preventing POAF. This study aimed to explore the effect of different pharmacological interventions for prophylaxis against POAF after cardiac surgery using network meta-analysis (NMA).Methods and analysisA systematic search will be performed in PubMed, EMBASE and the Cochrane Library to identify RCTs, systematic reviews, meta-analyses or NMA of different pharmacological interventions for POAF. We will evaluate the risk of bias of the included RCTs according to the Cochrane Handbook V.5.1.0, and use GRADE to assess the quality of evidence. Standard pairwise meta-analysis, trial sequential analysis and Bayesian network meta-analysis will be used to compare the efficacy of different pharmacological interventions.Ethics and disseminationEthics approval and patient consent are not required as this study is a meta-analysis based on published studies. The results of this NMA and trial sequential analysis will be submitted to a peer-reviewed journal for publication.Protocol registration numberCRD42017067492.

Timing and Route of Amiodarone for Prevention of Postoperative Atrial Fibrillation after Cardiac Surgery: A Network Regression Meta-analysis

2013 ◽  
Vol 36 (8) ◽  
pp. 1017-1023 ◽  
Author(s):  
SAURAV CHATTERJEE ◽  
PARTHA SARDAR ◽  
DEBABRATA MUKHERJEE ◽  
EDGAR LICHSTEIN ◽  
SHAMIK AIKAT
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Meta Analysis ◽  
Postoperative Atrial Fibrillation

scholarly journals Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients after Cardiac Surgery

2018 ◽  
Vol 67 (02) ◽  
pp. 107-116 ◽  
Author(s):  
Kennosuke Yamashita ◽  
Nan Hu ◽  
Ravi Ranjan ◽  
Craig Selzman ◽  
Derek Dosdall
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Meta Analysis ◽  
Postoperative Atrial Fibrillation ◽  
Clinical Risk Factors ◽  
Systemic Review ◽  
Left Ventricular Ejection ◽  
Clinical Risk

Background Postoperative atrial fibrillation (POAF) is a common arrhythmia following cardiac surgery and is associated with increased health-care costs, complications, and mortality. The etiology of POAF is incompletely understood and its prediction remains suboptimal. Using data from published studies, we performed a systemic review and meta-analysis to identify preoperative clinical risk factors associated with patients at increased risk of POAF. Methods A systematic search of PubMed, MEDLINE, and EMBASE databases was performed. Results Twenty-four studies that reported univariate analysis results regarding POAF risk factors, published from 2001 to May 2017, were included in this meta-analysis with a total number of 36,834 subjects. Eighteen studies were performed in the United States and Europe and 16 studies were prospective cohort studies. The standardized mean difference (SMD) between POAF and non-POAF groups was significantly different (reported as [SMD: 95% confidence interval, CI]) for age (0.55: 0.47–0.63), left atrial diameter (0.45: 0.15–0.75), and left ventricular ejection fraction (0.30: 0.14–0.47). The pooled odds ratios (ORs) (reported as [OR: 95% CI]) demonstrated that heart failure (1.56: 1.31–1.96), chronic obstructive pulmonary disease (1.36: 1.13–1.64), hypertension (1.29: 1.12–1.48), and myocardial infarction (1.18: 1.05–1.34) were significant predictors of POAF incidence, while diabetes was marginally significant (1.06: 1.00–1.13). Conclusion The present analysis suggested that older age and history of heart failure were significant risk factors for POAF consistently whether the included studies were prospective or retrospective datasets.

Sign in / Sign up

Export Citation Format

Share Document