Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic review and meta-analysis
Purpose Postoperative atrial fibrillation (POAF) is a potentially lethal and morbid complication after open heart surgery. This systematic review and meta-analysis aimed to investigate metoprolol compared with other treatments for prophylaxis against POAF. Methods We searched CENTRAL, MEDLINE,...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia
2020
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| Subjects: | |
| Online Access: | http://eprints.usm.my/47936/ http://eprints.usm.my/47936/1/2020%20Metoprolol_BMJ%20Open-OCR.pdf |
| _version_ | 1848881017851478016 |
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| author | Mohd, Noor Norhayati Ismail, Saiful Bahari Zaharah, Sulaiman Hussain, Nik Hazlina Nik Zainuddin, Mohammad Aimanazrul Muhammad, Irfan |
| author_facet | Mohd, Noor Norhayati Ismail, Saiful Bahari Zaharah, Sulaiman Hussain, Nik Hazlina Nik Zainuddin, Mohammad Aimanazrul Muhammad, Irfan |
| author_sort | Mohd, Noor Norhayati |
| building | USM Institutional Repository |
| collection | Online Access |
| description | Purpose Postoperative atrial fibrillation (POAF) is a
potentially lethal and morbid complication after open heart
surgery. This systematic review and meta-analysis
aimed
to investigate metoprolol compared with other treatments
for prophylaxis against POAF.
Methods We searched CENTRAL, MEDLINE, EMBASE
and trial registries for randomised controlled trials that
evaluated metoprolol for preventing the occurrence of
POAF after surgery against other treatments or placebo.
Random-effects
model was used for estimating the risk
ratios (RRs) and mean differences with 95% CIs.
Results Nine trials involving 1570 patients showed
metoprolol reduced POAF compared with placebo (416
patients; RR 0.46, 95% CI 0.33 to 0.66; I²=21%; risk
difference (RD) –0.19, 95% CI –0.28 to –0.10). However,
metoprolol increased the risk of POAF compared with
carvedilol (159 patients; RR 1.59, 95% CI 1.20 to 2.12;
I²=4%; RD 0.13, 95% CI 0.06 to 0.20). There was no
difference when compared with sotalol or amiodarone.
The occurrence of cardiovascular conditions after drugs
administration or death between the groups was not
different. The overall quality of evidence was moderate
to high. Subgroup analysis and funnel plot were not
performed.
Conclusions Metoprolol is effective in preventing POAF
compared with placebo and showed no difference with
class III antiarrhythmic drugs. Death and thromboembolism
are associated with open heart surgery, but not significant
in relation to the use of metoprolol. |
| first_indexed | 2025-11-15T18:12:20Z |
| format | Article |
| id | usm-47936 |
| institution | Universiti Sains Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-15T18:12:20Z |
| publishDate | 2020 |
| publisher | Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | usm-479362020-11-25T04:00:26Z http://eprints.usm.my/47936/ Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic review and meta-analysis Mohd, Noor Norhayati Ismail, Saiful Bahari Zaharah, Sulaiman Hussain, Nik Hazlina Nik Zainuddin, Mohammad Aimanazrul Muhammad, Irfan R Medicine Purpose Postoperative atrial fibrillation (POAF) is a potentially lethal and morbid complication after open heart surgery. This systematic review and meta-analysis aimed to investigate metoprolol compared with other treatments for prophylaxis against POAF. Methods We searched CENTRAL, MEDLINE, EMBASE and trial registries for randomised controlled trials that evaluated metoprolol for preventing the occurrence of POAF after surgery against other treatments or placebo. Random-effects model was used for estimating the risk ratios (RRs) and mean differences with 95% CIs. Results Nine trials involving 1570 patients showed metoprolol reduced POAF compared with placebo (416 patients; RR 0.46, 95% CI 0.33 to 0.66; I²=21%; risk difference (RD) –0.19, 95% CI –0.28 to –0.10). However, metoprolol increased the risk of POAF compared with carvedilol (159 patients; RR 1.59, 95% CI 1.20 to 2.12; I²=4%; RD 0.13, 95% CI 0.06 to 0.20). There was no difference when compared with sotalol or amiodarone. The occurrence of cardiovascular conditions after drugs administration or death between the groups was not different. The overall quality of evidence was moderate to high. Subgroup analysis and funnel plot were not performed. Conclusions Metoprolol is effective in preventing POAF compared with placebo and showed no difference with class III antiarrhythmic drugs. Death and thromboembolism are associated with open heart surgery, but not significant in relation to the use of metoprolol. Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia 2020-10-31 Article NonPeerReviewed application/pdf en http://eprints.usm.my/47936/1/2020%20Metoprolol_BMJ%20Open-OCR.pdf Mohd, Noor Norhayati and Ismail, Saiful Bahari and Zaharah, Sulaiman and Hussain, Nik Hazlina Nik and Zainuddin, Mohammad Aimanazrul and Muhammad, Irfan (2020) Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic review and meta-analysis. Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic review and meta-analysis. (Submitted) |
| spellingShingle | R Medicine Mohd, Noor Norhayati Ismail, Saiful Bahari Zaharah, Sulaiman Hussain, Nik Hazlina Nik Zainuddin, Mohammad Aimanazrul Muhammad, Irfan Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic review and meta-analysis |
| title | Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic
review and meta-analysis |
| title_full | Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic
review and meta-analysis |
| title_fullStr | Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic
review and meta-analysis |
| title_full_unstemmed | Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic
review and meta-analysis |
| title_short | Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic
review and meta-analysis |
| title_sort | metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac surgery patients: systematic
review and meta-analysis |
| topic | R Medicine |
| url | http://eprints.usm.my/47936/ http://eprints.usm.my/47936/1/2020%20Metoprolol_BMJ%20Open-OCR.pdf |