Skip to main content
SpringerLink
Log in

Are beta-blockers effective for preventing post-coronary artery bypass grafting atrial fibrillation? Direct and network meta-analyses

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Atrial fibrillation is the most common arrhythmia in clinical practice and is a major contributor to mortality. Recently, several studies have reported different results for treatments aimed at reducing the risk of postoperative AF.

Aims

The aim of this study was to evaluate the efficacy of beta-blockers (BBs) in preventing post-coronary artery bypass grafting (CABG) AF and to compare the efficacies of different BB treatments using a network meta-analytical approach.

Methods

The PubMed, EMBASE and Cochrane Library databases were searched (Jan 1995 to May 2014) to identify randomized controlled trials. Two independent investigators separately extracted the data using a seven-point scoring system to assess randomization, allocation concealment, blinding, withdrawals and dropouts. A direct meta-analysis of these randomized controlled trials was conducted. Then, six trials comparing different BB treatments for the prevention of postoperative AF were added to perform a Bayesian network meta-analysis with mixed treatment comparisons.

Results

Treatment with BBs was associated with a significant reduction in the postoperative incidence of AF compared with placebo/control [22.37 % compared with 34.45 %, relative risk (RR) = 0.53, 95 % confidence interval (CI): 0.37–0.75, p < 0.00001].

Conclusions

The network meta-analysis revealed no significant differences among eight types of BB treatments but did provide a ranking. BB treatments could significantly reduce the occurrence of post-CABG AF. Insufficient evidence was available to show that one BB treatment was more effective than the others were. According to our network meta-analysis, bisoprolol and landiolol+bisoprolol are better alternatives compared with the other treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cox JL (1993) A perspective of postoperative atrial fibrillation in cardiac operations. Ann Thorac Surg 56(3):405–409

    Article  CAS  PubMed  Google Scholar 

  2. Mariscalco G, Engstrom KG (2009) Postoperative atrial fibrillation is associated with late mortality after coronary surgery, but not after valvular surgery. Ann Thorac Surg 88(6):1871–1876. doi:10.1016/j.athoracsur.2009.07.074

    Article  PubMed  Google Scholar 

  3. Kaw R, Hernandez AV, Masood I, Gillinov AM, Saliba W, Blackstone EH (2011) Short- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 141(5):1305–1312. doi:10.1016/j.jtcvs.2010.10.040

    Article  PubMed  Google Scholar 

  4. Babin-Ebell J, Keith PR, Elert O (1996) Efficacy and safety of low-dose propranolol versus diltiazem in the prophylaxis of supraventricular tachyarrhythmia after coronary artery bypass grafting. Eur J Cardiothorac Surg: Off J Eur Assoc Cardiothorac Surg 10(6):412–416

    Article  CAS  Google Scholar 

  5. Wenke K, Parsa MH, Imhof M, Kemkes BM (1999) Efficacy of metoprolol in prevention of supraventricular arrhythmias after coronary artery bypass grafting. Z Kardiol 88(9):647–652

    Article  CAS  PubMed  Google Scholar 

  6. Lucio Ede A, Flores A, Blacher C, Leaes PE, Lucchese FA, Ribeiro JP (2004) Effectiveness of metoprolol in preventing atrial fibrillation and flutter in the postoperative period of coronary artery bypass graft surgery. Arq Bras Cardiol 82((1):42–46):37–41

    Google Scholar 

  7. Connolly SJ, Cybulsky I, Lamy A, Roberts RS, O’Brien B, Carroll S, Crystal E, Thorpe KE, Gent M, Beta-Blocker Length of Stay s (2003) Double-blind, placebo-controlled, randomized trial of prophylactic metoprolol for reduction of hospital length of stay after heart surgery: the beta-blocker length of stay (BLOS) study. Am Heart J 145(2):226–232. doi:10.1067/mhj.2003.147

    Article  CAS  PubMed  Google Scholar 

  8. Ogawa S, Okawa Y, Goto Y, Aoki M, Baba H (2013) Perioperative use of a beta blocker in coronary artery bypass grafting. Asian Cardiovasc Thorac Ann 21(3):265–269. doi:10.1177/0218492312451166

    Article  PubMed  Google Scholar 

  9. Sakaguchi M, Sasaki Y, Hirai H, Hosono M, Nakahira A, Seo H, Suehiro S (2012) Efficacy of landiolol hydrochloride for prevention of atrial fibrillation after heart valve surgery. Int Heart J 53(6):359–363

    Article  CAS  PubMed  Google Scholar 

  10. Paull DL, Tidwell SL, Guyton SW, Harvey E, Woolf RA, Holmes JR, Anderson RP (1997) Beta blockade to prevent atrial dysrhythmias following coronary bypass surgery. Am J Surg 173(5):419–421. doi:10.1016/S0002-9610(97)00077-9

    Article  CAS  PubMed  Google Scholar 

  11. Yazicioglu L, Eryilmaz S, Sirlak M, Inan MB, Aral A, Tasoz R, Akalin H (2002) The effect of preoperative digitalis and atenolol combination on postoperative atrial fibrillation incidence. Eur J Cardiothorac Surg: Off J Eur Assoc Cardiothorac Surg 22(3):397–401

    Article  Google Scholar 

  12. Imren Y, Benson AA, Zor H, Tasoglu I, Ereren E, Sinci V, Gokgoz L, Halit V (2007) Preoperative beta-blocker use reduces atrial fibrillation in off-pump coronary bypass surgery. ANZ J Surg 77(6):429–432. doi:10.1111/j.1445-2197.2007.04088.x

    Article  PubMed  Google Scholar 

  13. Sezai A, Nakai T, Hata M, Yoshitake I, Shiono M, Kunimoto S, Hirayama A (2012) Feasibility of landiolol and bisoprolol for prevention of atrial fibrillation after coronary artery bypass grafting: a pilot study. J Thorac Cardiovasc Surg 144(5):1241–1248. doi:10.1016/j.jtcvs.2012.06.042

    Article  CAS  PubMed  Google Scholar 

  14. Skiba MA, Pick AW, Chaudhuri K, Bailey M, Krum H, Kwa LJ, Rosenfeldt FL (2013) Prophylaxis against atrial fibrillation after cardiac surgery: beneficial effect of perioperative metoprolol. Heart Lung Circ 22(8):627–633. doi:10.1016/j.hlc.2012.12.017

    Article  PubMed  Google Scholar 

  15. Bert AA, Reinert SE, Singh AK (2001) A beta-blocker, not magnesium, is effective prophylaxis for atrial tachyarrhythmias after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 15(2):204–209. doi:10.1053/jcan.2001.21959

    Article  CAS  PubMed  Google Scholar 

  16. Khan MF, Wendel CS, Movahed MR (2013) Prevention of post-coronary artery bypass grafting (CABG) atrial fibrillation: efficacy of prophylactic beta-blockers in the modern era: a meta-analysis of latest randomized controlled trials. Ann Noninvasive Electrocardiol 18(1):58–68. doi:10.1111/anec.12004

    Article  PubMed  Google Scholar 

  17. Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, Egger M, Juni P (2011) Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ 342:c7086. doi:10.1136/bmj.c7086

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tang DH, Malone DC (2012) A network meta-analysis on the efficacy of serotonin type 3 receptor antagonists used in adults during the first 24 hours for postoperative nausea and vomiting prophylaxis. Clin Ther 34(2):282–294. doi:10.1016/j.clinthera.2012.01.007

    Article  CAS  PubMed  Google Scholar 

  19. Sezai A, Minami K, Nakai T, Hata M, Yoshitake I, Wakui S, Shiono M, Hirayama A (2011) Landiolol hydrochloride for prevention of atrial fibrillation after coronary artery bypass grafting: new evidence from the PASCAL trial. J Thorac Cardiovasc Surg 141(6):1478–1487. doi:10.1016/j.jtcvs.2010.10.045

    Article  CAS  PubMed  Google Scholar 

  20. Haghjoo M, Saravi M, Hashemi MJ, Hosseini S, Givtaj N, Ghafarinejad MH, Khamoushi AJ, Emkanjoo Z, Fazelifar AF, Alizadeh A, Sadr-Ameli MA (2007) Optimal beta-blocker for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery: carvedilol versus metoprolol. Heart Rhythm: Off J Heart Rhythm Soc 4(9):1170–1174. doi:10.1016/j.hrthm.2007.04.022

    Article  Google Scholar 

  21. Acikel S, Bozbas H, Gultekin B, Aydinalp A, Saritas B, Bal U, Yildirir A, Muderrisoglu H, Sezgin A, Ozin B (2008) Comparison of the efficacy of metoprolol and carvedilol for preventing atrial fibrillation after coronary bypass surgery. Int J Cardiol 126(1):108–113. doi:10.1016/j.ijcard.2007.03.123

    Article  PubMed  Google Scholar 

  22. Iliuta L, Christodorescu R, Filpescu D, Moldovan H, Radulescu B, Vasile R (2009) Prevention of perioperative atrial fibrillation with beta blockers in coronary surgery: betaxolol versus metoprolol. Interact Cardiovasc Thorac Surg 9(1):89–93. doi:10.1510/icvts.2009.202465

    Article  PubMed  Google Scholar 

  23. Marazzi G, Iellamo F, Volterrani M, Caminiti G, Madonna M, Arisi G, Massaro R, Righi D, Rosano GM (2011) Comparison of effectiveness of carvedilol versus bisoprolol for prevention of postdischarge atrial fibrillation after coronary artery bypass grafting in patients with heart failure. Am J Cardiol 107(2):215–219. doi:10.1016/j.amjcard.2010.08.062

    Article  CAS  PubMed  Google Scholar 

  24. Ozaydin M, Icli A, Yucel H, Akcay S, Peker O, Erdogan D, Varol E, Dogan A, Okutan H (2013) Metoprolol vs carvedilol or carvedilol plus N-acetyl cysteine on post-operative atrial fibrillation: a randomized, double-blind, placebo-controlled study. Eur Heart J 34(8):597–604. doi:10.1093/eurheartj/ehs423

    Article  CAS  PubMed  Google Scholar 

  25. Gross JL, Kramer CK, Leitao CB, Hawkins N, Viana LV, Schaan BD, Pinto LC, Rodrigues TC, Azevedo MJ, Diabetes, Endocrinology Meta-analysis G (2011) Effect of antihyperglycemic agents added to metformin and a sulfonylurea on glycemic control and weight gain in type 2 diabetes: a network meta-analysis. Ann Intern Med 154(10):672–679. doi:10.7326/0003-4819-154-10-201105170-00007

    Article  PubMed  Google Scholar 

  26. Leggett CL, Gorospe EC, Calvin AD, Harmsen WS, Zinsmeister AR, Caples S, Somers VK, Dunagan K, Lutzke L, Wang KK, Iyer PG (2014) Obstructive sleep apnea is a risk factor for Barrett’s esophagus. Clin Gastroenterol Hepatol: Off Clin Pract J Am Gastroenterol Assoc 12(4):583.e1–588.e1. doi:10.1016/j.cgh.2013.08.043

    Article  Google Scholar 

Download references

Acknowledgments

Sponsored by the National Natural Science Foundation of China (Grant No. 81000117, 81370266), and Natural Science Foundation of Shanghai (Grant No. 15ZR1413600).

Author information

Author notes

    Authors and Affiliations

    1. Department of Geriatrics, Shanghai First People’s Hospital Affiliated with Shanghai Jiaotong University, Shanghai, China

      T. Ji

    2. Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China

      C. Feng, Y. Bai, Q. Chen, Y. Qin, J. Zhu & X. Zhao

    3. Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China

      L. Sun

    4. Department of Health Statistics, Second Military Medical University, Shanghai, China

      X. Ye

    Authors
    1. T. Ji
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. C. Feng
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. L. Sun
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. X. Ye
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Y. Bai
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Q. Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Y. Qin
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. J. Zhu
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. X. Zhao
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding authors

    Correspondence to J. Zhu or X. Zhao.

    Ethics declarations

    Conflict of interest

    None declared.

    Ethical approval

    This article is a systematic review. There is no need to obtain ethical approval.

    Additional information

    T. Ji, C. Feng, and L. Sun contributed equally to this work.

    J. Zhu and X. Zhao also contributed equally to this work.

    Electronic supplementary material

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Ji, T., Feng, C., Sun, L. et al. Are beta-blockers effective for preventing post-coronary artery bypass grafting atrial fibrillation? Direct and network meta-analyses. Ir J Med Sci 185, 503–511 (2016). https://doi.org/10.1007/s11845-016-1447-1

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s11845-016-1447-1

    Keywords

    Search

    Navigation