title: Prophylaxis Against Atrial Fibrillation After General Thoracic Surgery: Trial Sequential Analysis and Network Meta-Analysis.
abstract: BACKGROUND
  Postoperative atrial fibrillation/flutter (POAF) is associated with significant morbidity and mortality after general thoracic surgery, but the need for and the best agent for prophylaxis remains obscure.
  
  
  METHODS
  A systematic literature search was performed to identify randomized controlled trials that compared regimens for POAF prophylaxis after general thoracic surgery. Random-effects meta-analyses with trial sequential analyses were performed to compare the effects of medical prophylaxis vs placebo/usual care. The risk of POAF among patients receiving various prophylactic regimens was subjected to Bayesian network meta-analysis.
  
  
  RESULTS
  Twenty-two trials (2,891 patients and 11 regimens) were included. Overall, medical prophylaxis reduced the incidence of POAF (OR, 0.33; 95% CI, 0.22-0.49) but not short-term mortality (OR, 0.85; 95% CI, 0.41-1.73). There was no significant difference in patient withdrawal due to adverse events (OR, 1.67; 95% CI, 0.67-4.16). Trial sequential analysis showed that as of 2012, sufficient evidence had accrued in support of the effectiveness of medical prophylaxis in reducing POAF after general thoracic surgery. In network meta-analysis, β-blockers, angiotensin-converting enzyme inhibitors, amiodarone, magnesium, and calcium channel blockers significantly reduced the risk of POAF compared with placebo/usual care. β-Blockers had the highest probability of being the most effective agents (OR, 0.12; 95% credible interval [CrI], 0.05-0.27; probability of being best, 77.7%; number needed to treat, 5.2).
  
  
  CONCLUSIONS
  The current literature supports the effectiveness and tolerability of medical prophylaxis and the superiority of β-blockers in preventing POAF after general thoracic surgery. β-Blockers are recommended, taking into consideration the status of the bronchopulmonary system.
authors.affiliation: Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Bing-Cheng
authors.initials: BC
authors.lastname: Zhao
authors.affiliation: Department of Ultrasonography, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Tong-Yi
authors.initials: TY
authors.lastname: Huang
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Qi-Wen
authors.initials: QW
authors.lastname: Deng
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Deng
authors.affiliation: Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Ke-Xuan
authors.initials: KX
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China. Electronic address: licaisysu@163.com.
authors.forename: Cai
authors.initials: C
authors.lastname: Li
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000145:classification / Q000494:pharmacology; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: atrial fibrillation; meta-analysis; postoperative; thoracic surgery