Although postoperative
atrial fibrillation is common after noncardiac surgery, there is a paucity of data regarding prophylaxis. We sought to determine whether pharmacologic prophylaxis reduces the incidence of postoperative
atrial fibrillation after noncardiac surgery.
METHODS: We performed an electronic search of Ovid MEDLINE, the Cochrane central register of controlled trials database, and SCOPUS from inception to September 7, 2016 and included prospective randomized studies in which patients in sinus rhythm underwent noncardiac surgery and examined the incidence of postoperative
atrial fibrillation as well as secondary safety outcomes.
RESULTS: Twenty-one studies including 11,608 patients were included. Types of surgery included
vascular surgery (3465 patients), thoracic surgery (2757 patients), general surgery (2292 patients),
orthopedic surgery (1756 patients), and other surgery (1338 patients). Beta-blockers (relative risk [RR] 0.32; 95% confidence interval [CI], 0.11-0.87),
amiodarone (RR 0.42; 95% CI, 0.26 to 0.67), and
statins (RR 0.43; 95% CI, 0.27 to 0.68) reduced postoperative
atrial fibrillation compared with placebo or active controls.
Calcium channel blockers (RR 0.55; 95% CI, 0.30 to 1.01),
digoxin (RR 1.62; 95% CI, 0.95 to 2.76), and
magnesium (RR 0.73; 95% CI, 0.23 to 2.33) had no statistically significant effect on postoperative
atrial fibrillation incidence. The incidence of adverse events was comparable across agents, except for increased mortality (RR 1.33; 95% CI, 1.03 to 1.37) and
bradycardia (RR 2.74; 95% CI, 2.19 to 3.43) in patients receiving beta-blockers.
CONCLUSIONS: