Prophylactic ablation during cardiac surgery in patients without atrial fibrillation: a systematic review and meta-analysis of randomized trials.

Autor:	Visanji M; Department of Medicine, McMaster University, Hamilton, ON, Canada., Belley-Côté EP; Department of Medicine, McMaster University, Hamilton, ON, Canada.; Population Health Research Institute, Hamilton, ON, Canada., Pandey A; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada., Amit Y; Department of Physiology, McGill University, Montreal, QC, Canada., McClure GR; Population Health Research Institute, Hamilton, ON, Canada.; Department of Surgery, McMaster University, Hamilton, ON, Canada., Young J; Health Sciences Library, McMaster University, Hamilton, ON, Canada., Um KJ; Department of Medicine, McMaster University, Hamilton, ON, Canada.; Population Health Research Institute, Hamilton, ON, Canada., Oraii A; Population Health Research Institute, Hamilton, ON, Canada., Healey JS; Department of Medicine, McMaster University, Hamilton, ON, Canada.; Population Health Research Institute, Hamilton, ON, Canada., Whitlock RP; Population Health Research Institute, Hamilton, ON, Canada.; Department of Surgery, McMaster University, Hamilton, ON, Canada., McIntyre WF; Department of Medicine, McMaster University, Hamilton, ON, Canada.; Population Health Research Institute, Hamilton, ON, Canada.
Jazyk:	angličtina
Zdroj:	Interdisciplinary cardiovascular and thoracic surgery [Interdiscip Cardiovasc Thorac Surg] 2024 Dec 03; Vol. 39 (6).
DOI:	10.1093/icvts/ivae195
Abstrakt:	Objectives: Atrial fibrillation is the most common complication of cardiac surgery and occurs frequently in patients without a history of the arrhythmia. We conducted a systematic review and meta-analysis of randomized controlled trials to assess whether prophylactic ablation during cardiac surgery in patients without a history of atrial fibrillation prevents atrial fibrillation. Methods: We searched CENTRAL, MEDLINE and Embase from inception to August 2024. We included randomized trials of adults without a history of atrial fibrillation undergoing cardiac surgery. The intervention of interest was ablation during surgery. We pooled data using random-effects models. The primary outcome was new-onset early postoperative atrial fibrillation within 30 days following surgery. The key secondary outcome was incident clinical atrial fibrillation at follow-up (minimum 6 months). We assessed risk of bias using the Cochrane Collaboration's risk of bias tool v.2 and evidence quality using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results: We included 7 trials (n = 687). The intervention was pulmonary vein isolation in 6 trials and ganglion plexi ablation in 1. Patients who received prophylactic ablation were less likely to have early postoperative atrial fibrillation (21% vs 37%, risk ratio [RR] 0.5, 95% confidence interval 0.3-0.8, I2 = 64%) and incident clinical atrial fibrillation at longest follow-up (range 6 months-2 years; 3% vs 10%, RR 0.3, 95% confidence interval 0.2-0.7, I2 = 0%). The quality of evidence was low. Conclusions: Prophylactic ablation during cardiac surgery may prevent atrial fibrillation in patients without a history of the arrhythmia. A definitive randomized trial is needed to confirm effects and safety. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu