• Teresa Cafaro, Melissa Allwood, William F McIntyre, Lily J Park, Julian Daza, Sandra N Ofori, Ke WangMichaelMPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada., Flavia K Borges, David Conen, Maura Marcucci, Jeff S Healey, Richard P Whitlock, Andre Lamy, Emilie P Belley-Côté, Jessica D Spence, Michael McGillion, and P J Devereaux.
• Population Health Research Institute, McMaster University, Hamilton, ON, Canada. teresa.cafaro@mcgill.ca.
• Can J Anaesth. 2023 Nov 1; 70 (11): 182818381828-1838.

PurposePostoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. Although the evidence suggests that beta blockers prevent POAF, they often cause hypotension. Landiolol, an ultra-short-acting β1 blocker, may prevent POAF, without adverse hemodynamic consequences.SourceWe searched MEDLINE, CENTRAL, Embase, and trial registries between January 1970 and March 2022. We included randomized controlled trials (RCTs) that evaluated the effect of landiolol for the prevention of POAF after cardiac surgery. Two reviewers independently assessed eligibility, extracted data, and assessed risk of bias using the Risk of Bias 2.0 tool. We pooled data using random-effects models. We used the Grading of Recommendations, Assessment, Development and Evaluations framework to assess certainty of evidence.Principal FindingsNine RCTs including 868 participants met the eligibility criteria. Patients randomized to landiolol (56/460) had less POAF compared with controls (133/408) with a relative risk (RR) of 0.40 (95% confidence interval [CI], 0.30 to 0.54; I2 = 0%;) and an absolute risk of 12.2% vs 32.6% (absolute risk difference, 20.4%; 95% CI, 15.0 to 25.0). Landiolol resulted in a shorter hospital length-of-stay (LOS) (268 patients; mean difference, -2.32 days; 95% CI, -4.02 to -0.57; I2 = 0%). We found no significant difference in bradycardia (RR, 1.11; 95% CI, 0.48 to 2.56; I2 = 0%). No hypotension was reported with landiolol. We judged the certainty of evidence as moderate for POAF (because of indirectness as outcomes were not clearly defined) and low for LOS (because of imprecision and concern of reporting bias).ConclusionIn patients undergoing cardiac surgery, landiolol likely reduces POAF and may reduce LOS. A definitive large RCT is needed to confirm these findings.Study RegistrationPROSPERO (CRD42021262703); registered 25 July 2021.© 2023. The Author(s).

15 keywords...

hide…