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Meta-analysis of antiarrhythmic therapy in the prevention of postoperative atrial fibrillation and the effect on hospital length of stay, costs, cerebrovascular accidents, and mortality in patients undergoing cardiac surgery

      There have been 13 randomized controlled trials of prophylactic antiarrhythmic therapy in patients undergoing cardiac surgery that have assessed its effects on hospital length of stay.
      • Laub G.W.
      • Janeira L.
      • Muralidharan S.
      • Riebman J.B.
      • Chen C.
      • Neary M.
      • Fernandez J.
      • Adkins M.S.
      • McGrath L.B.
      Prophylactic procainiamide for prevention of atrial fibrillation after coronary artery bypass grafting a prospective, double-blind, randomized, placebo-controlled pilot study.
      ,
      • Daoud E.
      • Strickberger S.
      • Man K.
      • Goyal R.
      • Deeb G.
      • Bolling S.
      • Pagani F.
      • Bitar C.
      • Meissner M.
      • Morady F.
      Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery.
      ,
      • Gerstenfeld E.
      • Hill M.
      • French S.
      • Mehra R.
      • Rofino K.
      • Salm T.
      • Mittleman R.
      Evaluation of right atrial and biatrial temporary pacing for the prevention of atrial fibrillation after coronary artery bypass surgery.
      ,
      • Gomes J.
      • Ip J.
      • Santoni-Rugiu F.
      • Mehta D.
      • Ergin A.
      • Lansman S.
      • Pe E.
      • Newhouse T.
      • Chao S.
      Oral d,l sotalol reduces the incidence of postoperative atrial fibrillation in coronary artery bypass surgery patients a randomized, double-blind, placebo-controlled study.
      ,
      • Guarnieri T.
      • Nolan S.
      • Gottlieb S.
      • Dudek A.
      • Lowry D.
      Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery the Amiodarone Reduction in Coronary Heart (ARCH) trial.
      ,
      • Redle J.
      • Khurana S.
      • Marzan R.
      • McCullough P.
      • Stewart J.
      • Westveer D.
      • O’Neill W.
      • Bassett J.
      • Tepe N.
      • Frumin H.
      Prophylactic oral amiodarone compared with placebo for prevention of atrial fibrillation after coronary artery bypass surgery.
      ,
      • Chung M.
      • Augostini R.
      • Asher C.
      • Pool D.
      • Grady T.
      • Zikri M.
      • Buehner S.
      • Weinstock M.
      • McCarthy P.
      Ineffectiveness and potential proarrhythmia of atrial pacing for atrial fibrillation prevention after coronary artery bypass grafting.
      ,
      • Dorge H.
      • Schoendube F.
      • Schoberer M.
      • Stellbrink C.
      • Voss M.
      • Messmer B.
      Intraoperative amiodarone as prophylaxis against atrial fibrillation after coronary operations.
      ,
      • Fan K.
      • Lee K.
      • Chiu C.
      • Lee J.
      • He G.
      • Cheung D.
      • Sun M.
      • Lau C.
      Effects of biatrial pacing in prevention of postoperative atrial fibrillation after coronary artery bypass surgery.
      ,
      • Greenberg M.
      • Katz N.
      • Iuliano S.
      • Tempesta B.
      • Solomon A.
      Atrial pacing for the prevention of atrial fibrillation after cardiovascular surgery.
      ,
      • Daoud E.G.
      • Dabir R.
      • Archambeau M.
      • Morady F.
      • Strickberger A.
      Randomized, double-blind trial of simultaneous right and left atrial epicardial pacing for prevention of post-open heart surgery atrial fibrillation.
      ,
      • Lee S.
      • Chang C.
      • Lu M.
      • Lee R.
      • Cheng J.
      • Hung C.
      • Chen S.
      Intravenous amiodarone for prevention of atrial fibrillation after coronary artery bypass grafting.
      ,
      • Giri S.
      • White C.M.
      • Dunn A.B.
      • Felton K.
      • Freeman-Bosco L.
      • Reddy P.
      • Tsikouris J.P.
      • Wilcox H.A.
      • Kluger J.
      Oral amiodarone for prevention of atrial fibrillation after open heart surgery the Atrial Fibrillation Suppression Trial (AFIST): a randomized placebo-controlled trial.
      These have shown consistent and marked decreases in the incidence of atrial fibrillation (AF), but the effects on hospital stay have been less concordant. Correlation of a decreased incidence of this arrhythmia with a reduction in hospital length of stay, costs, morbidity, or mortality would help determine how much continuing effort should be placed on its prevention. To determine whether this decreased incidence translates into clinically important outcomes, we conducted a meta-analysis of various antiarrhythmic therapies and their effects on the length of hospitalization, costs, stroke, and mortality.
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