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Meta-Analysis
. 2023 Nov;70(11):1828-1838.
doi: 10.1007/s12630-023-02586-0. Epub 2023 Nov 2.

Landiolol for the prevention of postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis

Teresa Cafaro  1   2   3   4   5 , Melissa Allwood  6 , William F McIntyre  7   8 , Lily J Park  9 , Julian Daza  10 , Sandra N Ofori  7   8 , Michael Ke Wang  7   8 , Flavia K Borges  7   8 , David Conen  7   8 , Maura Marcucci  7   8 , Jeff S Healey  7   8 , Richard P Whitlock  7   8 , Andre Lamy  7   8 , Emilie P Belley-Côté  7   8 , Jessica D Spence  7   8 , Michael McGillion  7   8 , P J Devereaux  7   8
Affiliations
Meta-Analysis

Landiolol for the prevention of postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis

Teresa Cafaro et al. Can J Anaesth. 2023 Nov.

Abstract
in English, French

Purpose: Postoperative 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.

Source: We 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 findings: Nine 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).

Conclusion: In patients undergoing cardiac surgery, landiolol likely reduces POAF and may reduce LOS. A definitive large RCT is needed to confirm these findings.

Study registration: PROSPERO (CRD42021262703); registered 25 July 2021.

RéSUMé: OBJECTIF: La fibrillation auriculaire postopératoire (FAPO) est une complication fréquente après une chirurgie cardiaque. Bien que les données probantes suggèrent que les bêta-bloqueurs préviennent la FAPO, ces agents provoquent souvent une hypotension. Le landiolol, un β1-bloqueur à action ultra-courte, pourrait prévenir la FAPO sans conséquences hémodynamiques indésirables.

Sources: Nous avons effectué des recherches dans les bases de données MEDLINE, CENTRAL et Embase, et dans les registres d’études publiées entre janvier 1970 et mars 2022. Nous avons inclus les études randomisées contrôlées (ERC) évaluant l’effet du landiolol pour la prévention de la FAPO après une chirurgie cardiaque. Deux personnes ont indépendamment révisé l’éligibilité, extrait les données et évalué le risque de biais à l’aide de l’outil Risque de biais 2.0. Nous avons regroupé les données à l’aide de modèles à effets aléatoires. Nous avons utilisé le système de notation GRADE (Grading of Recommendations Assessment, Development, and Evaluation) pour évaluer la certitude des données probantes.

Constatations principales: Neuf ERC incluant 868 personnes remplissaient les critères d’éligibilité. Les patient·es randomisé·es dans le groupe landiolol (56/460) présentaient moins de FAPO que les témoins (133/408), avec un risque relatif (RR) de 0,40 (intervalle de confiance [IC] à 95 %, 0,30 à 0,54; I2 = 0 %) et un risque absolu de 12,2 % vs 32,6 % (différence de risque absolue, 20,4 %; IC 95 % 95 %, 15,0 à 25,0). Le landiolol a entraîné une durée de séjour hospitalier plus courte (268 patient·es; différence moyenne, −2,32 jours; IC 95 %, −4,02 à −0,57; I2 = 0 %). Nous n’avons trouvé aucune différence significative en matière de bradycardie (RR, 1,11; IC 95 %, 0,48 à 2,56; I2 = 0 %). Aucune hypotension n’a été rapportée avec le landiolol. Nous avons jugé que la certitude des données probantes était modérée pour la FAPO (en raison du caractère indirect car les critères d’évaluation n’étaient pas clairement définis) et faible pour la durée de séjour hospitalier (en raison de l’imprécision et de questionnements concernant le biais de déclaration).

Conclusion: Chez les patient·es bénéficiant d’une chirurgie cardiaque, le landiolol réduit probablement la FAPO et peut réduire la durée de séjour hospitalier. Une ERC définitive à grande échelle est nécessaire pour confirmer ces résultats. ENREGISTREMENT DE L’éTUDE: PROSPERO (CRD42021262703); enregistrée le 25 juillet 2021.

Keywords: POAF; atrial fibrillation; landiolol; postoperative.

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Conflict of interest statement

All authors have no financial or personal conflicts of interest that could influence the content or interpretation of the manuscript. Additionally, the research discussed in the article has been conducted in an ethical and responsible manner.

Figures

Fig. 1
Fig. 1
Risk of bias summary: review authors’ judgements for each risk of bias item for each included study. Of note, Sasaki et al. included two interventions (different landiolol dosing) within their RCT. To overcome a unit-of-analysis error, results were split into two groups.
Fig. 2
Fig. 2
Individual and pooled effects of landiolol vs control on postoperative atrial fibrillation in patients who underwent cardiac surgery
Fig. 3
Fig. 3
Individual and pooled effects of landiolol vs control on hospital length of stay in the cardiac surgery setting
Fig. 4
Fig. 4
Individual and pooled effects of landiolol vs control on mortality in the cardiac surgery setting
Fig. 5
Fig. 5
Individual and pooled effects of landiolol vs control on congestive heart failure in the cardiac surgery setting
Fig. 6
Fig. 6
Individual and pooled effects of landiolol vs control on myocardial infarction in the cardiac surgery setting
Fig. 7
Fig. 7
Individual and pooled effects of landiolol vs control on stroke in the cardiac surgery setting
Fig. 8
Fig. 8
Individual and pooled effects of landiolol vs control on bradycardia in the cardiac surgery setting
See this image and copyright information in PMC

Comment in

References

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