Preoperative Antihypertensive Medication in Relation to Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis

Abstract

Background. We undertake a systematic review and meta-analysis to evaluate the effect of preoperative hypertension and preoperative antihypertensive medication to postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to March 2016) for eligible studies. The outcomes were the effects of preoperative hypertension, preoperative calcium antagonists regimen, preoperative ACE inhibitors regimen, and preoperative beta blocking agents regimen with POAF. We calculated pooled risk ratios (OR) and 95% CIs using random- or fixed-effects models. Results. Twenty-five trials involving 130087 patients were listed. Meta-analysis showed that the number of preoperative hypertension patients in POAF group was significantly higher (P < 0.05), while we found that there are no significant differences between two groups in Asia patients by subgroup analysis, which is in contrast to other outcomes. Compared with the Non-POAF group, the number of patients who used calcium antagonists and ACE inhibitors preoperatively in POAF group was significantly higher (P < 0.05). And we found that there were no significant differences between two groups of preoperative beta blocking agents used (P = 0.08). Conclusions. Preoperative hypertension and preoperative antihypertensive medication in patients undergoing cardiac operations seem to be associated with higher risk of POAF.

Risk and protective factors for atrial fibrillation after cardiac surgery and valvular interventions: an umbrella review of meta-analyses

“… 32 Hypertension is a well-established risk factor for AF, 33 and its adequate management during the preoperative period may protect against POAF by reducing both high left ventricular filling pressures and easing atrial stretch. 32–34 …”

“…28 31 One of the modifiable preoperative factors associated with POAF, supported by highly convincing evidence, was hypertension. 32 Hypertension is a well-established risk factor for AF, 33 and its adequate management during the preoperative period may protect against POAF by reducing both high left ventricular filling pressures and easing atrial stretch. [32][33][34] In our study, the most critical perioperative protective factors for POAF prevention, that did not involve medical therapy, were atrial or biatrial pacing and posterior pericardiotomy, both supported by high GLE.…”

“…32 Hypertension is a well-established risk factor for AF, 33 and its adequate management during the preoperative period may protect against POAF by reducing both high left ventricular filling pressures and easing atrial stretch. [32][33][34] In our study, the most critical perioperative protective factors for POAF prevention, that did not involve medical therapy, were atrial or biatrial pacing and posterior pericardiotomy, both supported by high GLE. 35 Overdrive atrial pacing might prevent POAF by reducing the risk of bradycardia and bradycardiamediated atrial ectopic beats.…”

Oral Pregabalin in Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…We prospectively registered our system review at PROSPERO (registration number: CRD42020203862). We followed the methods of Wang et al 2017 [12].…”

Atrial Fibrillation After Coronary Artery Bypass Surgery: Risk Factors, Prevention and Treatment

“…Все перечисленные факторы определяют актуальность изучения данного осложнения у пациентов после АКШ. [34].…”