Mohd, Noor Norhayati and Ismail, Saiful Bahari and Zaharah, Sulaiman and Hussain, Nik Hazlina Nik and Zainuddin, Mohammad Aimanazrul and Muhammad, Irfan
(2020)
Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic
review and meta-analysis.
Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic review and meta-analysis.
(Submitted)
Abstract
Purpose Postoperative atrial fibrillation (POAF) is a
potentially lethal and morbid complication after open heart
surgery. This systematic review and meta-analysis
aimed
to investigate metoprolol compared with other treatments
for prophylaxis against POAF.
Methods We searched CENTRAL, MEDLINE, EMBASE
and trial registries for randomised controlled trials that
evaluated metoprolol for preventing the occurrence of
POAF after surgery against other treatments or placebo.
Random-effects
model was used for estimating the risk
ratios (RRs) and mean differences with 95% CIs.
Results Nine trials involving 1570 patients showed
metoprolol reduced POAF compared with placebo (416
patients; RR 0.46, 95% CI 0.33 to 0.66; I²=21%; risk
difference (RD) –0.19, 95% CI –0.28 to –0.10). However,
metoprolol increased the risk of POAF compared with
carvedilol (159 patients; RR 1.59, 95% CI 1.20 to 2.12;
I²=4%; RD 0.13, 95% CI 0.06 to 0.20). There was no
difference when compared with sotalol or amiodarone.
The occurrence of cardiovascular conditions after drugs
administration or death between the groups was not
different. The overall quality of evidence was moderate
to high. Subgroup analysis and funnel plot were not
performed.
Conclusions Metoprolol is effective in preventing POAF
compared with placebo and showed no difference with
class III antiarrhythmic drugs. Death and thromboembolism
are associated with open heart surgery, but not significant
in relation to the use of metoprolol.
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