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Pharmacological interventions for preventing atrial fibrillation after lung surgery: systematic review and meta-analysis

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Abstract

Background

Postoperative atrial fibrillation/flutter (POAF) is one of the most common cardiac complications after lung surgery. We aimed to assess the safety and efficacy of pharmacological interventions for new-onset POAF prophylaxis in patients with lung cancer after lung surgery.

Methods

PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were searched to identify randomized controlled trials comparing the effects of pharmacological interventions to prevent POAF following lung surgery.

Results

A total number of 19 studies with 2,922 participants were included. Pharmacological interventions significantly reduced the incidence of POAF (odds ratio [OR] 0.36, 95% confidence interval [95% CI] 0.26–0.52) while did not increase the incidence of severe pulmonary complications (OR 1.17, 95% CI 0.57–2.41) after lung surgery compared with placebo/usual care. Among different trials, beta-blockers appeared to be the most effective with an OR of 0.13 (95% CI, 0.07–0.27) and a number needed-to-treat (NNT) of 3.63 and was considered safe with no serious adverse events recorded. The risk of POAF decreased from 25.6 to 11.4% (P < 0.001) overall and from 34.2 to 6.7% (P < 0.001) with beta-blockers as monotherapy. Pharmacological interventions did not reduce the 30-day mortality (OR 0.89, 95% CI 0.43–1.84, I2 = 0%), but showed a trend toward reducing major cardiovascular complications including myocardial ischemia/infarction, cardiac arrest, heart failure, and stroke (OR 0.41, 95% CI 0.13–1.29, I2 = 0%).

Conclusion

Current clinical evidence supports the effectiveness of pharmacological intervention with beta-blockers, amiodarone, magnesium sulfate, or calcium-channel blockers to reduce the incidence of POAF after lung surgery in patients with lung cancer. In the absence of contraindications, prophylaxis with beta-blockers seems to be the most effective of the treatments studied.

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Authors and Affiliations

  1. Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China

    **aomei Wang, Demei Zhang, **g**g Han, Guangling Li & Xueya Guo

  2. Department of Cardiology, First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China

    Yanxia Ren

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**aomei Wang and Demei Zhang designed the study, performed statistical analysis, interpreted the data and wrote the first draft. The corresponding author had full access to the data and had final responsibility for the decision to submit for publication. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Xueya Guo.

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Wang, X., Zhang, D., Ren, Y. et al. Pharmacological interventions for preventing atrial fibrillation after lung surgery: systematic review and meta-analysis. Eur J Clin Pharmacol 78, 1777–1790 (2022). https://doi.org/10.1007/s00228-022-03383-2

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