Carvedilol for prevention of atrial fibrillation after cardiac surgery: a meta-analysis.
BACKGROUND
Postoperative 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.


OBJECTIVE
To investigate the efficacy of carvedilol in preventing POAF.


METHODS
PubMed 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.


RESULTS
Carvedilol 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.


CONCLUSIONS
In 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.
Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, Liaoning Province, China.
Hui-Shan
HS
Wang
Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, Liaoning Province, China.
Zeng-Wei
ZW
Wang
Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, Liaoning Province, China.
Zong-Tao
ZT
Yin
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D002227:Carbazoles / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D000077261:Carvedilol; D018890:Chemoprevention; D002986:Clinical Trials as Topic; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011412:Propanolamines / Q000627:therapeutic use*; D017594:Publication Bias; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol