Postoperative Atrial Fibrillation Prophylaxis After Lung Surgery: Systematic Review and Meta-Analysis

• Published in: The Annals of thoracic surgery Vol. 98; no. 6; pp. 1989 - 1997
• Main Authors: Riber, Lars Peter, MD, PhD, Larsen, Torben Bjerregaard, MD, PhD, Christensen, Thomas Decker, MD, DMSc
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.12.2014
• Subjects: Anti-Arrhythmia Agents - therapeutic use; Atrial Fibrillation - etiology; Atrial Fibrillation - prevention & control; Cardiothoracic Surgery; Humans; Pneumonectomy - adverse effects; Postoperative Complications - prevention & control; Risk Factors; Surgery; 24; 10
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2014.06.069

Background Atrial fibrillation after thoracic surgery is frequent and increases morbidity and mortality. A number of trials have investigated medical prophylaxis for the prevention of atrial fibrillation after surgery for lung cancer. However, the literature is diverse and hence difficult to review. The aim of this study was to evaluate the safety and efficacy of reducing the risk of postoperative atrial fibrillation by the use of medical prophylaxis in patients undergoing surgery for lung cancer. Methods A systematic review and meta-analysis of randomized, controlled trials investigating prophylactic medical interventions to reduce the risk of postoperative atrial fibrillation was performed. Results A total number of 10 trials were identified. A significant reduction in the risk of postoperative atrial fibrillation was found with a relative risk of 0.53 (95% confidence interval, 0.42 to 0.67) and a number needed-to-treat of 8.5 (95% confidence interval, 6.4 to 13.3). Amiodarone was found to be the most effective prophylactic agent with a relative risk of 0.32 (95% confidence interval, 0.19 to 0.50) and a number needed-to-treat of 4.8 (95% confidence interval, 3.7 to 7.6) and regarded as safe, with no severe adverse events registered. The risk of atrial fibrillation was overall reduced from 25.1% to 13.4% ( p  < 0.001) and for amiodarone as a single therapy from 30.4% to 9.6% ( p < 0.001). Conclusions Medical prophylaxis with calcium-channel blockers, magnesium sulfate, or amiodarone significantly reduces the risk of developing atrial fibrillation after lung reduction surgery. However, amiodarone and magnesium sulfate were the most effective and safest drugs causing no increased risk of adverse events.