Amiodarone vs. sotalol as prophylaxis against atrial fibrillation/flutter after heart surgery: a meta-analysis.
BACKGROUND
The incidence of supraventricular arrhythmias remains high following open-heart surgery. The most common of these arrhythmias are atrial fibrillation and flutter (AFF), for which treatment is not well defined. Recent studies have focused on prophylactically treating patients in an attempt to reduce postoperative AFF. Several studies have shown that sotalol and amiodarone are both effective in reducing AFF following heart surgery. However, no studies have been done comparing both drugs.


METHODS
A meta-analysis was done to compare the efficacy of sotalol and amiodarone after bypass graft surgery. Randomized controlled trials were included if patients were clearly monitored, and the incidence of AFF was noted. Ten studies were included in the final analysis.


RESULTS
Both amiodarone and sotalol were more effective than placebo treatment in reducing the incidence of postoperative AFF. However, when the data were pooled, no differences were noted between amiodarone and sotalol for efficacy (sotalol, - 21.5%; 95% confidence interval [CI], - 28.3 to - 14.6; amiodarone, - 14.1%; CI, - 20.1 to - 8.1), length of stay (sotalol, - 0.13 d; CI, - 0.33 to 0.07 d; amiodarone, - 0.18; CI, - 0.38 to 0.02 d), or adverse drug reactions causing drug termination (sotalol, 9.7%; CI, 0.086 to 19.3; amiodarone, 1.95%; CI, - 0.48 to 4.38).


CONCLUSIONS
This data would suggest that either drug could be used in a prophylactic regimen to reduce the incidence of AFF following heart surgery.
Wurdeman
Richard L
RL
Creighton University School of Pharmacy and Allied Health Professions, Omaha, NE, USA. rwurdem@cardiac.creighton.edu
Mooss
Aryan N
AN
Mohiuddin
Syed M
SM
Lenz
Thomas L
TL
D000368:Aged; D000638:Amiodarone / Q000009:adverse effects / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000517:prevention & control*; D001282:Atrial Flutter / Q000175:diagnosis / Q000517:prevention & control*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013015:Sotalol / Q000009:adverse effects / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D000638:Amiodarone