Abstract 17467: Carvedilol Outperforms Metoprolol in Preventing Postoperative Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract

Introduction: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. Current guidelines suggest beta-blockers for the prevention of POAF. Carvedilol is a nonselective beta-blocker with anti-inflammatory, antioxidant, and various cationic channel-blocking effects. This meta-analysis aims to compare the efficacy of carvedilol versus metoprolol in the prevention of POAF. Methods: We considered randomized controlled studies (RCTs) and retrospective studies that demonstrated the efficacy of carvedilol versus metoprolol in the prevention of POAF. Pooled data were analyzed using either the fixed-effect or random-effect model in Review Manager 5.3. The incidence of POAF was the primary endpoint, while mortality rate and bradycardia were secondary outcomes. Results: A total of five RCTs and two retrospective studies (1000 patients) were included in this meta-analysis. The overall effect did not favor either of the two groups in terms of mortality rate [Risk ratio 0.45, 95 % CI (0.1-1.97), P=0.29] as well as incidence of bradycardia [Risk ratio 0.63, 95 % CI (0.32-1.23), P=0.17]. However, the incidence of POAF was lower in patients who received carvedilol compared to metoprolol [Risk ratio 0.54, 95 % CI (0.42-0.71), P < 0.00001]. Conclusion: In patients undergoing cardiac surgery, carvedilol has been shown to successfully minimize the occurrence of POAF. It appeared to be more effective than metoprolol. To definitively establish the efficacy of carvedilol compared to metoprolol and other beta-blockers in the prevention of POAF, large-scale, well-designed randomized controlled trials are required.