Prevention of post-coronary artery bypass grafting (CABG) atrial fibrillation: Efficacy of prophylactic beta-blockers in the modern era: A meta-analysis of latest randomized controlled trials

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Abstract

Background Atrial fibrillation/flutter (AF) is a common complication of open heart surgery and ACC/AHA guidelines strongly recommend the use of prophylactic beta-blockers (BB) for its prevention. Several recent studies, however, have failed to show the desired protective effects of BB against post-coronary artery bypass grafting (CABG) AF. As the protocols of CABG, medical management of CAD (coronary artery disease) and demographic features of the patients undergoing open heart surgery have evolved significantly over the last two decades, we decided to perform a review of evidence from latest randomized controlled trials (RCTs) to confirm the efficacy of prophylactic BB. Methods We searched for RCTs comparing the efficacy of prophylactic BB versus placebo/control against post-CABG AF. We limited our search to 1995 till present to reflect ongoing advancements in the protocols of CABG and the medical management of CAD. Initially, 34 trials were selected; however after certain exclusions only 10 RCTs were included in the final analysis. Results Prophylactic BB decreased the incidence of post-CABG AF from 32.8% in the control group to 20% in the prophylactic group with risk ratio (RR) of 0.50 with 95% CI of 0.36-0.69, P value < 0.001. In a subgroup analysis, carvedilol appears to be superior to metoprolol for the prevention of postoperative AF. Conclusions Despite several limitations, this analysis confirms the efficacy of prophylactic BB against post-CABG AF in this era. We recommend continuing perioperative BB in the open heart surgery patients in the absence of contraindications.

Original languageEnglish (US)
Pages (from-to)58-68
Number of pages11
JournalAnnals of Noninvasive Electrocardiology
Volume18
Issue number1
DOIs
StatePublished - Jan 2013

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Atrial Flutter
Coronary Artery Bypass
Atrial Fibrillation
Meta-Analysis
Randomized Controlled Trials
Thoracic Surgery
Coronary Artery Disease
Metoprolol
Odds Ratio
Placebos
Demography
Guidelines
Control Groups
Incidence

Keywords

  • atrial fibrillation
  • beta-blockers
  • CABG
  • meta-analysis
  • prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{8a13ecaec81f453a97386b4f9e13a924,
title = "Prevention of post-coronary artery bypass grafting (CABG) atrial fibrillation: Efficacy of prophylactic beta-blockers in the modern era: A meta-analysis of latest randomized controlled trials",
abstract = "Background Atrial fibrillation/flutter (AF) is a common complication of open heart surgery and ACC/AHA guidelines strongly recommend the use of prophylactic beta-blockers (BB) for its prevention. Several recent studies, however, have failed to show the desired protective effects of BB against post-coronary artery bypass grafting (CABG) AF. As the protocols of CABG, medical management of CAD (coronary artery disease) and demographic features of the patients undergoing open heart surgery have evolved significantly over the last two decades, we decided to perform a review of evidence from latest randomized controlled trials (RCTs) to confirm the efficacy of prophylactic BB. Methods We searched for RCTs comparing the efficacy of prophylactic BB versus placebo/control against post-CABG AF. We limited our search to 1995 till present to reflect ongoing advancements in the protocols of CABG and the medical management of CAD. Initially, 34 trials were selected; however after certain exclusions only 10 RCTs were included in the final analysis. Results Prophylactic BB decreased the incidence of post-CABG AF from 32.8{\%} in the control group to 20{\%} in the prophylactic group with risk ratio (RR) of 0.50 with 95{\%} CI of 0.36-0.69, P value < 0.001. In a subgroup analysis, carvedilol appears to be superior to metoprolol for the prevention of postoperative AF. Conclusions Despite several limitations, this analysis confirms the efficacy of prophylactic BB against post-CABG AF in this era. We recommend continuing perioperative BB in the open heart surgery patients in the absence of contraindications.",
keywords = "atrial fibrillation, beta-blockers, CABG, meta-analysis, prevention",
author = "Khan, {Muhammad Fahad} and Wendel, {Christopher S} and Movahed, {Mohammad R}",
year = "2013",
month = "1",
doi = "10.1111/anec.12004",
language = "English (US)",
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journal = "Annals of Noninvasive Electrocardiology",
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AU - Khan, Muhammad Fahad

AU - Wendel, Christopher S

AU - Movahed, Mohammad R

PY - 2013/1

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N2 - Background Atrial fibrillation/flutter (AF) is a common complication of open heart surgery and ACC/AHA guidelines strongly recommend the use of prophylactic beta-blockers (BB) for its prevention. Several recent studies, however, have failed to show the desired protective effects of BB against post-coronary artery bypass grafting (CABG) AF. As the protocols of CABG, medical management of CAD (coronary artery disease) and demographic features of the patients undergoing open heart surgery have evolved significantly over the last two decades, we decided to perform a review of evidence from latest randomized controlled trials (RCTs) to confirm the efficacy of prophylactic BB. Methods We searched for RCTs comparing the efficacy of prophylactic BB versus placebo/control against post-CABG AF. We limited our search to 1995 till present to reflect ongoing advancements in the protocols of CABG and the medical management of CAD. Initially, 34 trials were selected; however after certain exclusions only 10 RCTs were included in the final analysis. Results Prophylactic BB decreased the incidence of post-CABG AF from 32.8% in the control group to 20% in the prophylactic group with risk ratio (RR) of 0.50 with 95% CI of 0.36-0.69, P value < 0.001. In a subgroup analysis, carvedilol appears to be superior to metoprolol for the prevention of postoperative AF. Conclusions Despite several limitations, this analysis confirms the efficacy of prophylactic BB against post-CABG AF in this era. We recommend continuing perioperative BB in the open heart surgery patients in the absence of contraindications.

AB - Background Atrial fibrillation/flutter (AF) is a common complication of open heart surgery and ACC/AHA guidelines strongly recommend the use of prophylactic beta-blockers (BB) for its prevention. Several recent studies, however, have failed to show the desired protective effects of BB against post-coronary artery bypass grafting (CABG) AF. As the protocols of CABG, medical management of CAD (coronary artery disease) and demographic features of the patients undergoing open heart surgery have evolved significantly over the last two decades, we decided to perform a review of evidence from latest randomized controlled trials (RCTs) to confirm the efficacy of prophylactic BB. Methods We searched for RCTs comparing the efficacy of prophylactic BB versus placebo/control against post-CABG AF. We limited our search to 1995 till present to reflect ongoing advancements in the protocols of CABG and the medical management of CAD. Initially, 34 trials were selected; however after certain exclusions only 10 RCTs were included in the final analysis. Results Prophylactic BB decreased the incidence of post-CABG AF from 32.8% in the control group to 20% in the prophylactic group with risk ratio (RR) of 0.50 with 95% CI of 0.36-0.69, P value < 0.001. In a subgroup analysis, carvedilol appears to be superior to metoprolol for the prevention of postoperative AF. Conclusions Despite several limitations, this analysis confirms the efficacy of prophylactic BB against post-CABG AF in this era. We recommend continuing perioperative BB in the open heart surgery patients in the absence of contraindications.

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