Timing and Route of Amiodarone for Prevention of Postoperative Atrial Fibrillation after Cardiac Surgery: A Network Regression Meta-analysis

Background: We attempted to evaluate if an oral-only regimen was as effective in preventing postoperative atrial fibrillation (POAF) after cardiac surgery, in comparison to a regimen that included intravenous (IV) administration using a network meta-analysis of available data, and also attempted to assess if preoperative administration at least 1 day before surgery was superior to postoperative prophylaxis (at least 1 day after surgery). Methods: We searched PubMed, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials' databases for randomized controlled trials conducted between 1990 and 2011 that assessed rates of POAF with amiodarone. Finally an interaction odds ratio was computed to assess the efficacy of an oral-only regimen of amiodarone compared to one including IV administration and to evaluate if preoperative amiodarone was superior to postoperative prophylaxis. Results: Twenty-three studies (total N = 3,950) were included. Both regimens of amiodarone improved risk of POAF; oral-only risk ratio (RR) was 0.59 (95% confidence interval [CI] 0.49-0.70; P < 0.01) and regimen including IV RR was 0.57 (95% CI 0.43-0.75, P < 0.01). The interaction odds ratio was 1.17 (95% CI 0.72-1.89, P = 0.533). Both preoperative amiodarone (P < 0.01) and postoperative prophylaxis were effective (P = 0.0009), irrespective of duration. Conclusions: This systematic review suggests a regimen of both oral-only and one including IV administration, as well pre- and postoperative administration of amiodarone is effective in prevention of POAF after cardiac surgery.