title: Perioperative landiolol administration reduces atrial fibrillation after cardiac surgery: A meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiac surgery. Patients who develop POAF have a prolonged stay in the intensive care unit and hospital and an increased risk of postoperative stroke. Many guidelines for the management of cardiac surgery patients, therefore, recommend perioperative administration of beta-blockers to prevent and treat POAF. Landiolol is an ultra-short acting beta-blocker, and some randomized controlled trials of landiolol administration for the prevention of POAF have been conducted in Japan. This meta-analysis evaluated the effectiveness of landiolol administration for the prevention of POAF after cardiac surgery.
  
  
  METHODS
  The Medline/PubMed and BioMed Central databases were searched for randomized controlled trials comparing cardiac surgery patients who received perioperative landiolol with a control group (saline administration, no drug administration, or other treatment). Two independent reviewers selected the studies for inclusion. Data regarding POAF and safety outcomes were extracted. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method (fixed effects model).
  
  
  RESULTS
  Six trials with a total of 560 patients were included in the meta-analysis. Landiolol administration significantly reduced the incidence of POAF after cardiac surgery (OR 0.26, 95% CI 0.17-0.40). The effectiveness of landiolol administration was similar in three groups: all patients who underwent coronary artery bypass grafting (CABG) (OR 0.27, 95% CI 0.17-0.43), patients who underwent CABG compared with a control group who received saline or nothing (OR 0.28, 95% CI 0.17-0.45), and all patients who underwent cardiac surgery compared with a control group who received saline or nothing (OR 0.27, 95% CI 0.17-0.42). Only two adverse events associated with landiolol administration were observed (2/302, 0.7%): hypotension in one patient and asthma in one patient.
  
  
  CONCLUSIONS
  Landiolol administration reduces the incidence of POAF after cardiac surgery and is well tolerated.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan, no1-saka@nms.ac.jp.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Sakamoto
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Hamasaki
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kitakaze
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D009025:Morpholines / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014508:Urea / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000319:Adrenergic beta-Antagonists; D009025:Morpholines; C077049:landiolol; D014508:Urea
references.citation: PLoS Med. 2009 Jul 21;6(7):e1000097
references.pmid: 19621072
references.citation: Can J Cardiol. 2011 Jan-Feb;27(1):91-7
references.pmid: 21329866
references.citation: Biometrics. 1994 Dec;50(4):1088-101
references.pmid: 7786990
references.citation: Chest. 2007 Mar;131(3):833-839
references.pmid: 17356100
references.citation: Drugs. 2013 Jun;73(9):959-77
references.pmid: 23760735
references.citation: Circ J. 2012;76(5):1097-101
references.pmid: 22361918
references.citation: Br J Pharmacol. 2005 Feb;144(3):317-22
references.pmid: 15655528
references.citation: J Anesth. 2002;16(3):265-7
references.pmid: 14517655
references.citation: J Cardiovasc Pharmacol. 1999 Jul;34(1):70-7
references.pmid: 10413070
references.citation: Int Heart J. 2012;53(6):359-63
references.pmid: 23258136
references.citation: Can J Anaesth. 2001 Nov;48(10):985-9
references.pmid: 11698317
references.citation: Chem Pharm Bull (Tokyo). 1992 Jun;40(6):1462-9
references.pmid: 1356643
references.citation: J Cardiovasc Surg (Torino). 2012 Jun;53(3):369-74
references.pmid: 22249647
references.citation: J Thorac Cardiovasc Surg. 2011 Jun;141(6):1478-87
references.pmid: 21269646
references.citation: Ann Thorac Cardiovasc Surg. 2014;20(2):129-34
references.pmid: 23445797
references.citation: Circulation. 2009 Nov 24;120(21):e169-276
references.pmid: 19884473
references.citation: Circulation. 2011 Dec 6;124(23):e652-735
references.pmid: 22064599
references.citation: Asian Cardiovasc Thorac Ann. 2013 Jun;21(3):265-9
references.pmid: 24570490
references.citation: Eur Heart J. 2014 Oct 1;35(37):2541-619
references.pmid: 25173339
references.citation: J Thorac Cardiovasc Surg. 2012 Nov;144(5):1241-8
references.pmid: 22858430
references.citation: J Am Coll Cardiol. 2010 Mar 30;55(13):1370-6
references.pmid: 20338499