Background: Atrial tachyarrhythmia is the most common complication after general thoracic surgery and is associated with significant morbidity, longer hospital stay, and higher costs. We sought to determine whether the use of antiarrhythmic medications is associated with a reduced rate of postoperative atrial tachyarrhythmia.
Methods: MEDLINE, EMBASE, Cochrane Database of clinical trials (1980-2003), and reference lists of relevant articles were searched for randomized controlled trials with placebo control, general thoracic patients, and noncombined and prophylactic use of the medications. Search, data abstraction, and analyses were performed and confirmed by at least 2 authors. A fixed-effects model was used to perform meta-analyses.
Results: There were 11 unique trials (total n = 1294) that met the inclusion criteria. Calcium-channel blockers and beta-blockers reduced the risk of atrial tachyarrhythmia in 4 and 2 trials, respectively (relative risk of 0.50 and 95% confidence interval of 0.34-0.73; relative risk of 0.40 and 95% confidence interval of 0.17-0.95, respectively). However, beta-blockers tended to increase the risk of pulmonary edema (relative risk, 2.15; 95% confidence interval, 0.74-6.23). Magnesium tested in one unblinded trial also reduced the risk of atrial tachyarrhythmia (relative risk, 0.4; 95% confidence interval, 0.21-0.78). On the other hand, digitalis preparations were found to be harmful because they increased the risk of atrial tachyarrhythmia in 3 trials (relative risk, 1.51; 95% confidence interval, 1.00-2.28). Finally, 2 other medications, flecainide and amiodarone, were each tested in a single small trial, and their effects were associated with great uncertainty.
Conclusions: Calcium-channel blockers and beta-blockers are effective in reducing postoperative atrial tachyarrhythmia. The use of these medications should be individualized, and possible adverse events of beta-blockers should be taken into account. Randomized clinical trials do not support the use of digitalis in general thoracic surgery. The value of magnesium as a supplement to a main prophylactic regimen should be explored.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jtcvs.2004.07.042 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
A New Mechanism of Supraventricular Tachycardia: Gene Mutation.
Curr Cardiol Rev
January 2025
Department of Cardiology, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China.
Background: Supraventricular tachycardia (SVT) is very common in daily clinical practice, especially in the emergency department, with rapid onset and urgent management. The review highlights the recent genetic predispositions and mechanisms in SVT.
Methods: Through analysis of epidemiology, familial clustering, and gene mutations of the relevant literatureļ¼the review elucidates the genetic properties and potential pathophysiology of SVT.
Cardiotoxic Effects Following CAR-T Cell Therapy: A Literature Review.
Curr Oncol Rep
January 2025
Department of Radiology, Albert Einstein College of Medicine and the Montefiore Medical Center, 111 East 210Th Street, Bronx, NY, 10461, USA.
Purpose Of Review: This paper reviewed the current literature on incidence, clinical manifestations, and risk factors of Chimeric Antigen Receptor T-cell (CAR-T) cardiotoxicity.
Recent Findings: CAR-T therapy has emerged as a groundbreaking treatment for hematological malignancies since FDA approval in 2017. CAR-T therapy is however associated with a few side effects, among which cardiotoxicity is of significant concern.
Ablation of slow activation areas in addition to pulmonary vein isolation improves the maintenance of the sinus rhythm in patients with persistent atrial fibrillation.
J Interv Card Electrophysiol
January 2025
Department of Cardiology, Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
Background: Slow activation areas, characterized by decreased conduction velocities in the left atrium, are commonly observed in patients with persistent atrial fibrillation (PeAF). However, it remains unclear whether the ablation of slow activation areas combined with pulmonary vein isolation (PVI) improves clinical outcomes in these patients.
Methods: This single-center retrospective study included patients who underwent catheter ablation for PeAF.
Anesthesia management for cesarean delivery in patients with an arterial switch operation: a single center case series (2015-2023).
Int J Obstet Anesth
November 2024
Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
Background: Arterial switch operation (ASO) for dextro-transposition of the great arteries was developed four decades ago, and women with ASO have reached childbearing age. Although over 40% of the pregnant women who received ASO gave birth via cesarean delivery, detailed information about anesthesia management has not been reported. This study aimed to evaluate anesthesia and perioperative outcomes in pregnant women with ASO undergoing cesarean delivery.
View Article and Find Full Text PDFBackground: Anti-N-methyl-D-aspartic receptor encephalitis (Anti-NMDAR encephalitis) is the most prevalent form of autoimmune encephalitis in pediatric patients. Autonomic dysfunction is a frequent symptom of Anti-NMDAR encephalitis, yet it often goes unnoticed by pediatricians. Studies have indicated that pediatric patients with autonomic dysfunction exhibit a poorer prognosis compared to those without.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!