title: The efficacy of sotalol in preventing postoperative atrial fibrillation: a meta-analysis.
abstract: OBJECTIVE
  Supraventricular tachyarrhythmias including atrial fibrillation are common and troubling complications after cardiac surgery, and thus considerable interest in pharmacologic prophylaxis has developed. The aim of this study was to evaluate the efficacy of sotalol in the prevention of postoperative supraventricular tachyarrhythmias.
  
  
  METHODS
  Standard methods of meta-analysis were used. Randomized clinical trials published in English language were eligible for the meta-analysis.
  
  
  RESULTS
  A systematic review revealed 15 eligible publications that provided 20 comparisons of sotalol with a control group. The incidence and relative risk (RR) with 95% confidence interval (CI) of developing postoperative supraventricular tachyarrhythmias while taking sotalol were sotalol (n=489) versus placebo (n=499): 22.5% versus 41.5%, RR=0.55 (CI, 0.454-0.667, P<.001); sotalol (n=304) versus no treatment (n=311): 12% versus 39%, RR=0.329 (CI, 0.236-0.459, P<.001); sotalol (n=488) versus beta-blocker (n=555): 14% versus 23%, RR=0.644 (CI, 0.495-0.838, P<.001); sotalol (n=139) versus amiodarone (n=146): no significant differences in supraventricular tachyarrhythmia prevention; and sotalol (n=51) versus magnesium (n=54): no significant differences in supraventricular tachyarrhythmia prevention. Initiating sotalol orally or intravenously had no significant effect on efficacy. Initiating sotalol after surgery showed a trend toward less adverse events (before: RR=1.700 [CI, 0.903-3.200] and after: RR=0.767 [CI, 0.391-1.505]).
  
  
  CONCLUSIONS
  Sotalol is more effective in the prevention of supraventricular tachyarrhythmia than placebo or beta-blockers. Initiating sotalol before cardiac surgery has no advantage compared with initiating sotalol shortly after surgery. Starting sotalol intravenously after surgery may be a more reliable method than administering via a nasogastric tube or delaying treatment until the patient can take oral medication.
authors.affiliation: Department of Medicine, Section of Cardiology, Wayne State University Medical School, Detroit, MI, USA. nzkerin@gmail.com
authors.forename: Nicholas Z
authors.initials: NZ
authors.lastname: Kerin
authors.forename: Sony
authors.initials: S
authors.lastname: Jacob
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000187:drug effects; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D007262:Infusions, Intravenous; D008274:Magnesium / Q000009:adverse effects / Q000627:therapeutic use; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013015:Sotalol / Q000009:adverse effects / Q000627:therapeutic use*; D013617:Tachycardia, Supraventricular / Q000517:prevention & control*
chemical_list: D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D008274:Magnesium