Prevention of atrial fibrillation after cardiac surgery using low-dose landiolol: A systematic review and meta-analysis

Study objective Atrial fibrillation (AF) is associated with mortality after cardiac surgery. Several studies have reported that landiolol might help to prevent postoperative AF. The objective of this study was to investigate whether low-dose landiolol is useful in terms of balance of benefit and risk. Design We conducted a meta-analysis after systematically searching the PubMed, the Cochrane library and the ICHUSHI to identify randomized, controlled trials investigating the preventive effect of landiolol on incidence of AF after cardiac surgery. Patients Six randomized trial with 571 patients were included. Measurements The primary outcome was incidence of AF after surgery, while secondary outcomes were mortality and complications. Main results Incidence of AF within 1 week after surgery was significantly lower in the landiolol group than in the control group (odds ratio, 0.27; 95% confidence interval, 0.18–0.42; p < 0.001). Three of the 6 studies reported data regarding in-hospital mortality and complications, showing no significant differences between groups (0.7 vs 3.0%; OR, 0.45; 95% CI, 0.07–2.74; p = 0.39; and 4.5 vs 9.7%; OR, 0.45; 95% CI, 0.16–1.23; p = 0.12, respectively). Conclusions Our systematic review revealed that low-dose landiolol might help to prevent AF after cardiac surgery and further large trials are needed to evaluate safety because mortality and morbidity rate were very low in included studies.