Effects of amiodarone and thoracic epidural analgesia on atrial fibrillation after coronary artery bypass grafting

Nygård, Eigil; Sørensen, Lars H.; Hviid, Lamia Bada; Pedersen, Finn Møller; Ravn, Jesper; Thomassen, Lars; Svendsen, Jesper Hastrup; Eliasen, K.; Krogsgaard, Kim; Aldershvile, Jan

doi:10.1053/j.jvca.2004.08.006

Cited by 22 publications

(6 citation statements)

References 32 publications

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“…Eighteen trials (3295 patients), with a variety of dosing strategies, have evaluated amiodarone for the prevention of post-operative AF ( Figure 2, Table 1, Supplementary material, Figure S3). 44,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] Amiodarone reduced AF from an average incidence of 33.2% in the control group to 19.8% (OR 0.48, 95% CI 0.40-0.57). In the amiodarone trials, 3.4% in the control groups and 6.8% in the amiodarone groups had bradycardia (OR 1.66, 95% CI 1.73-2.47).…”

Section: Amiodaronementioning

confidence: 98%

Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis

Burgess

Kilborn

Keech

2006

European Heart Journal

299

226

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Section: Amiodaronementioning

confidence: 98%

Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis

Burgess

Kilborn

Keech

2006

European Heart Journal

299

226

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“…We shortlisted 51 RCTs (2112 TEA and 2220 GA) in the meta-analysis (Figure 1). 6,7,20,21,36–82 The pooled age (TEA: 62.8 years; 95% CI, 60.8–64.8 versus GA: 62.7 years; 95% CI, 60.6–64.7), body mass index (BMI; TEA: 27.7; 95% CI, 26.8–28.7 versus GA: 27.9; 95% CI, 26.8–29.0), and left ventricular ejection fraction (LVEF, TEA: 55.1%; 95% CI, 51.8–58.3 versus GA: 54.8%; 95% CI, 49.8–59.8) were similar between both groups. Forty-three studies were solely on coronary artery bypass grafts, while 8 studies included other cardiac surgeries such as valve replacements, including combined coronary artery bypass and valve replacement surgeries.…”

Section: Resultsmentioning

confidence: 99%

Thoracic Epidural Anesthesia in Cardiac Surgery: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials

Chiew

Low

Zeng

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Research on fast-track recovery protocols postulates that thoracic epidural anesthesia (TEA) in cardiac surgery contributes to improved postoperative outcomes. However, concerns about TEA’s safety hinder its widespread usage. We conducted a systematic review and meta-analysis to assess the benefits and risks of TEA in cardiac surgery. METHODS: We searched 4 databases for randomized controlled trials (RCTs) assessing the use of TEA against only general anesthesia (GA) in adults undergoing cardiac surgery, up till June 4, 2022. We conducted random-effects meta-analyses, evaluated risk of bias using the Cochrane Risk-of-Bias 2 tool, and rated certainty of evidence via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Primary outcomes were intensive care unit (ICU), hospital length of stay, extubation time (ET), and mortality. Other outcomes included postoperative complications. Trial sequential analysis (TSA) was conducted on all outcomes to elicit statistical and clinical benefit. RESULTS: Our meta-analysis included 51 RCTs (2112 TEA patients and 2220 GA patients). TEA significantly reduced ICU length of stay (−6.9 hours; 95% confidence interval [CI], −12.5 to −1.2; P = .018), hospital length of stay (−0.8 days; 95% CI, −1.1 to −0.4; P < .0001), and ET (−2.9 hours; 95% CI, −3.7 to −2.0; P < .0001). However, we found no significant change in mortality. TSA found that the cumulative Z-curve passed the TSA-adjusted boundary for ICU length of stay, hospital length of stay, and ET, suggesting a clinical benefit. TEA also significantly reduced pain scores, pooled pulmonary complications, transfusion requirements, delirium, and arrhythmia, without additional complications such as epidural hematomas, of which the risk was estimated to be <0.14%. CONCLUSIONS: TEA reduces ICU and hospital length of stay, and postoperative complications in patients undergoing cardiac surgery with minimal reported complications such as epidural hematomas. These findings favor the use of TEA in cardiac surgery and warrant consideration for use in cardiac surgeries worldwide.

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“…The size of the RCT ranged from 50 to 163 (total 540). Three studies in this meta-analysis enrolled patients undergoing CABG with CPB technique [15,16,18], the remaining two studies included patients undergoing CABG with OPCAB technique [17,19]. The quality of the included studies was assessed by the Jadad score.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of randomized controlled trials on the efficacy of thoracic epidural anesthesia in preventing atrial fibrillation after coronary artery bypass grafting

Wei

Huang

et al. 2012

BMC Cardiovasc Disord

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BackgroundPostoperative atrial fibrillation (POAF) is one of the most common complications in patients undergoing coronary artery bypass grafting (CABG). The goal of this meta-analysis was to evaluate the efficacy of thoracic epidural anesthesia (TEA) in preventing POAF in adult patients undergoing CABG.MethodsMEDLINE and EMBASE were searched to identify randomized controlled trails in adult patients undergoing CABG who were randomly assigned to receive general anesthesia plus thoracic epidural anesthesia (GA + TEA) or general anesthesia only (GA). Two authors independently extracted data using a standardized Excel file. The primary outcome measure was the incidence of POAF. We used DerSimonian-Laird random-effects models to compute summary risk ratios with 95% confidence intervals.ResultsFive studies involving 540 patients met our inclusion criteria. No significant difference in the incidence of POAF was observed between the two groups (risk ratio, 0.61; 95% confidence interval, 0.33 to 1.12; P = 0.11), with significant heterogeneity among the studies (I2 = 73%, P = 0.005). Sensitivity analyses by primary endpoint, methodological quality and surgical technique yielded similar results.ConclusionsThe limited evidence suggests that TEA shows no beneficial efficacy in preventing POAF in adult patients undergoing CABG. However, the results of this meta-analysis should be interpreted with caution due to significant heterogeneity of the studies included. Thus, the potential infuence of TEA on the incidence of atrial fibrillation following CABG warrants further investigation.

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Effects of amiodarone and thoracic epidural analgesia on atrial fibrillation after coronary artery bypass grafting

Cited by 22 publications

References 32 publications

Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis

Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis

Thoracic Epidural Anesthesia in Cardiac Surgery: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials

Meta-analysis of randomized controlled trials on the efficacy of thoracic epidural anesthesia in preventing atrial fibrillation after coronary artery bypass grafting

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