Abstract
BackgroundPostoperative atrial fibrillation (POAF) remains the most common complication after cardiac surgery. Current guidelines recommend β-blockers to prevent POAF. Carvedilol is a non-selective β-adrenergic blocker with anti-inflammatory, antioxidant, and multiple cationic channel blocking properties. These unique properties of carvedilol have generated interest in its use as a prophylaxis for POAF.ObjectiveTo investigate the efficacy of carvedilol in preventing POAF.MethodsPubMed from the inception to September 2013 was searched for studies assessing the effect of carvedilol on POAF occurrence. Pooled relative risk (RR) with 95% confidence interval (CI) was calculated using random- or fixed-effect models when appropriate. Six comparative trials (three randomized controlled trials and three nonrandomized controlled trials) including 765 participants met the inclusion criteria.ResultsCarvedilol was associated with a significant reduction in POAF (relative risk [RR] 0.49, 95% confidence interval [CI] 0.37 to 0.64, p<0.001). Subgroup analyses yielded similar results. In a subgroup analysis, carvedilol appeared to be superior to metoprolol for the prevention of POAF (RR 0.51, 95% CI 0.37 to 0.70, p<0.001). No evidence of heterogeneity was observed.ConclusionsIn conclusion, carvedilol may effectively reduce the incidence of POAF in patients undergoing cardiac surgery. It appeared to be superior to metoprolol. A large-scale, well-designed randomized controlled trial is needed to conclusively answer the question regarding the utility of carvedilol in the prevention of POAF.
Highlights
Despite significant advances in anesthetic and surgical techniques, postoperative atrial fibrillation (POAF) remains the most common complication after cardiac surgery [1,2,3]
Carvedilol was associated with a significant reduction in Postoperative atrial fibrillation (POAF)
Carvedilol appeared to be superior to metoprolol for the prevention of POAF (RR 0.51, 95% confidence interval (CI) 0.37 to 0.70, p,0.001)
Summary
Despite significant advances in anesthetic and surgical techniques, postoperative atrial fibrillation (POAF) remains the most common complication after cardiac surgery [1,2,3]. The incidence of POAF varies from 11% to 40%, depending on the definition and the method of monitoring [1,2,3]. This arrhythmia is usually benign and self-limiting, it may result in hemodynamic instability, a longer hospital stay, and increased health care costs [1,2,3]. Postoperative atrial fibrillation (POAF) remains the most common complication after cardiac surgery. Carvedilol is a non-selective b-adrenergic blocker with antiinflammatory, antioxidant, and multiple cationic channel blocking properties These unique properties of carvedilol have generated interest in its use as a prophylaxis for POAF
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