The efficacy of sotalol in preventing postoperative atrial fibrillation: a meta-analysis
| Autor: | Nicholas Z. Kerin, Sony Jacob |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Tachycardia
medicine.medical_specialty Heart Diseases Placebo Amiodarone law.invention Electrocardiography Postoperative Complications Randomized controlled trial Double-Blind Method law Internal medicine Atrial Fibrillation Tachycardia Supraventricular Medicine Humans Magnesium Prospective Studies Adverse effect Infusions Intravenous Randomized Controlled Trials as Topic Postoperative Care business.industry Sotalol Atrial fibrillation General Medicine medicine.disease Cardiac surgery Anesthesia Cardiology Drug Therapy Combination medicine.symptom business Anti-Arrhythmia Agents medicine.drug |
| Zdroj: | The American journal of medicine. 124(9) |
| ISSN: | 1555-7162 |
| Popis: | Objective Supraventricular tachyarrhythmias including atrial fibrillation are common and troubling complications after cardiac surgery, and thus considerable interest in pharmacologic prophylaxis has developed. The aim of this study was to evaluate the efficacy of sotalol in the prevention of postoperative supraventricular tachyarrhythmias. Methods Standard methods of meta-analysis were used. Randomized clinical trials published in English language were eligible for the meta-analysis. Results A systematic review revealed 15 eligible publications that provided 20 comparisons of sotalol with a control group. The incidence and relative risk (RR) with 95% confidence interval (CI) of developing postoperative supraventricular tachyarrhythmias while taking sotalol were sotalol (n=489) versus placebo (n=499): 22.5% versus 41.5%, RR=0.55 (CI, 0.454-0.667, P 001); sotalol (n=304) versus no treatment (n=311): 12% versus 39%, RR=0.329 (CI, 0.236-0.459, P 001); sotalol (n=488) versus beta-blocker (n=555): 14% versus 23%, RR=0.644 (CI, 0.495-0.838, P 001); sotalol (n=139) versus amiodarone (n=146): no significant differences in supraventricular tachyarrhythmia prevention; and sotalol (n=51) versus magnesium (n=54): no significant differences in supraventricular tachyarrhythmia prevention. Initiating sotalol orally or intravenously had no significant effect on efficacy. Initiating sotalol after surgery showed a trend toward less adverse events (before: RR=1.700 [CI, 0.903-3.200] and after: RR=0.767 [CI, 0.391-1.505]). Conclusion Sotalol is more effective in the prevention of supraventricular tachyarrhythmia than placebo or beta-blockers. Initiating sotalol before cardiac surgery has no advantage compared with initiating sotalol shortly after surgery. Starting sotalol intravenously after surgery may be a more reliable method than administering via a nasogastric tube or delaying treatment until the patient can take oral medication. |
| Databáze: | OpenAIRE |
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