Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials.
This meta-analysis was performed to determine the efficacy of digoxin, verapamil, and beta-adrenoceptor blockers as prophylaxis against supraventricular arrhythmias (SVAs) after coronary artery bypass graft surgery (CABG). Randomized control trials were included if the electrocardiographic monitoring technique was clearly defined and extended through at least the first 3 postoperative days. Twenty-four of 69 identified studies were included in the final analysis. A summary odds ratio (OR) of the likelihood of developing SVAs after CABG in the treatment versus control groups was calculated. The pooled mean ventricular rate during SVA in patients who developed such an arrhythmia was also calculated. Neither digoxin nor verapamil reduced the likelihood of SVAs after CABG (digoxin: OR = 0.97, 95% confidence interval [CI] = 0.62-1.49; verapamil: OR = 0.91, CI = 0.57-1.46). The likelihood of developing an SVA in patients treated with beta-blockers was markedly decreased compared with controls (OR = 0.28, CI = 0.21-0.36). The pooled ventricular rate when SVAs did occur was significantly lower in each of the treatment groups. Prophylactic beta-adrenoceptor blockers had a protective effect against the development of SVAs in a select population of patients undergoing CABG. No such beneficial effect was demonstrated for digoxin or verapamil. All three classes of agents reduced the ventricular rate in patients who developed the arrhythmia, although the ventricular rate reduction was not clinically optimal.
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
T C
TC
Andrews
S C
SC
Reimold
J A
JA
Berlin
E M
EM
Antman
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004077:Digoxin / Q000627:therapeutic use*; D006801:Humans; D015201:Meta-Analysis as Topic; D016017:Odds Ratio; D014700:Verapamil / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D004077:Digoxin; D014700:Verapamil