The quality of evidence is downgraded by inconsistency (unexplained variability in results).
A Cochrane review [Abstract] 1 included 118 studies on prophylactic therapies against post-operative atrial fibrillation, with a total of 17 364 subjects. Interventions included amiodarone, beta-blockers, sotalol, magnesium, atrial pacing, and posterior pericardiotomy. Each of the studied interventions significantly reduced the rate of post-operative atrial fibrillation after cardiac surgery compared with a control. Beta-blockers (OR 0.33, 95% CI 0.26 to 0.43; statistical heterogeneity, I2 = 55%; 33 studies, n=4 698) and sotalol (OR 0.34, 95% CI 0.26 to 0.43; 11 studies, n=1 609) appear to have similar efficacy while magnesium's efficacy (OR 0.55, 95% CI 0.41 to 0.73; statistical heterogeneity, I2 = 51%; 21 studies, n=2 988) may be slightly less. Amiodarone (OR 0.43, 95% CI 0.34 to 0.54; statistical heterogeneity, I2 = 63%; 33 studies, n=5 402), atrial pacing (OR 0.47, 95% CI 0.36 to 0.61; statistical heterogeneity, I2 = 50%; 21 studies, n=2 933) and posterior pericardiotomy (OR 0.35, 95% CI 0.18 to 0.67; statistical heterogeneity, I2 = 66%; 6 studies, n=763) were all found to be effective. Prophylactic intervention decreased the hospital length of stay by approximately two-thirds of a day and decreased the cost of hospital treatment by roughly $1250 US. Intervention was also found to reduce the odds of post-operative stroke, though this reduction did not reach statistical significance (OR 0.69, 95% CI 0.47 to 1.01; 28 studies, n=6 361). No significant effect on all-cause or cardiovascular mortality was demonstrated.
Selection of appropriate interventions may depend on the individual patient situation and should take into consideration adverse effects and the cost associated with each approach.
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