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Review
. 2012 Aug 19:12:67.
doi: 10.1186/1471-2261-12-67.

Meta-analysis of randomized controlled trials on the efficacy of thoracic epidural anesthesia in preventing atrial fibrillation after coronary artery bypass grafting

Wan-Jie Gu  1 , Chun-Yin Wei, De-Qing Huang, Rui-Xing Yin
Affiliations
Review

Meta-analysis of randomized controlled trials on the efficacy of thoracic epidural anesthesia in preventing atrial fibrillation after coronary artery bypass grafting

Wan-Jie Gu et al. BMC Cardiovasc Disord. .

Abstract

Background: Postoperative atrial fibrillation (POAF) is one of the most common complications in patients undergoing coronary artery bypass grafting (CABG). The goal of this meta-analysis was to evaluate the efficacy of thoracic epidural anesthesia (TEA) in preventing POAF in adult patients undergoing CABG.

Methods: MEDLINE and EMBASE were searched to identify randomized controlled trails in adult patients undergoing CABG who were randomly assigned to receive general anesthesia plus thoracic epidural anesthesia (GA + TEA) or general anesthesia only (GA). Two authors independently extracted data using a standardized Excel file. The primary outcome measure was the incidence of POAF. We used DerSimonian-Laird random-effects models to compute summary risk ratios with 95% confidence intervals.

Results: Five studies involving 540 patients met our inclusion criteria. No significant difference in the incidence of POAF was observed between the two groups (risk ratio, 0.61; 95% confidence interval, 0.33 to 1.12; P = 0.11), with significant heterogeneity among the studies (I2 = 73%, P = 0.005). Sensitivity analyses by primary endpoint, methodological quality and surgical technique yielded similar results.

Conclusions: The limited evidence suggests that TEA shows no beneficial efficacy in preventing POAF in adult patients undergoing CABG. However, the results of this meta-analysis should be interpreted with caution due to significant heterogeneity of the studies included. Thus, the potential infuence of TEA on the incidence of atrial fibrillation following CABG warrants further investigation.

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Figures

Figure 1
Figure 1
Selection Process for RCTs Included in the Meta-analysis. CABG, coronary artery bypass grafting; POAF, postoperative atrial fibrillation; RCT, randomized controlled trials.
Figure 2
Figure 2
Forest plot for the incidence of POAF. There were no significant effects in preventing POAF as determined by the random-effects model. RR, relative risk; CI, confidence interval.
See this image and copyright information in PMC

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