Int J Clin Exp Med 2015;8(7):10265-10273 www.ijcem.com /ISSN:1940-5901/IJCEM0010429
Review Article Efficacy and safety of landiolol for prevention of atrial fibrillation after cardiac surgery: a meta-analysis of randomized controlled trials Liang Li1, Qing Ai2, Ling Lin1, Pu Ge1, Changming Yang3, Li Zhang1 Departments of 1Pathophysiology, 2Physiology, Chongqing Medical University, Chongqing, China; 3Department of Anesthesiology, The First People’s Hospital of Jingmen, Jingmen, Hubei Province, China Received May 20, 2015; Accepted July 11, 2015; Epub July 15, 2015; Published July 30, 2015 Abstract: Atrial fibrillation (AF) is a quite common complication during the postoperative period after cardiac surgery. Increasing studies have reported that landiolol may be effective in prevention of AF after cardiac surgery. Its efficacy and safety are seldom explored; hence we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of landiolol in prevention of AF after cardiac surgery. Databases of PubMed, Embase and Cochrane Central Register of Controlled Trials were searched from inception through to December 2014 for RCTs that explored the efficacy and safety of landiolol on the prevention of AF after cardiac surgery. Pooled results were expressed as risk ratios (RRs) with 95% confidence intervals (CIs). Nine eligible RCTs involving 807 patients were included in this meta-analysis. Compared with the control group, landiolol was associated with a significant reduction of AF after cardiac surgery (RR=0.41; 95% CI 0.32-0.52; P60 beats/min
Full-text
Sezai et al. [24]
2012/ Japan
77/34
68.3
81.2
Intravenous landiolol perioperatively at 5 mg/kg/min for 3 days, or receiving oral bisoprolol postoperatively together with landiolol
1 week after If arrhythmia persisted for surgery more than 5 minute sor affected hemodynamics and required treatment
Full-text
Osada et al. [25]
2012/ Japan
73/68
NA
NA
No treatment and Landiolol hydrochloride 2-3 mg/ oral carvedilol kg/min was started soon after extubation after arrival in the intensive care unit after surgery and was continued for 48 hours
NA
Abstract
Nagaoka et al. [26]
2013/ Japan
22/23
65.1
78.7
Off-pump CABG
Landiolol
Diltiazem
0.5 to 2 μg/min/kg to allow evaluation of the efficacy of landiolol at an ultra-low dose
1 week after Postoperative new-onset surgery atrial fibrillation or atrial flutter requiring treatment or lasting >5 min
Full-text
Ogawa et al. [27]
2013/ Japan
68/68
70.5
77.2
Off-pump CABG
Landiolol
No treatment
Started immediately after induc1 week after AF that continued for ≥10 min tion of anesthesia, with adjustsurgery ment of the dose between 3-5 mg/kg/min to control the heart rate at 60-90 beats/min; administration continued for 2 days after the operation
Full-text
Author
Heart valve Landiolol surgery
On-pump CABG
Landiolol or landiolol Saline with oral bisoprolol
All types of Landiolol open-heart surgery
Follow-up
Definition of AF Persistence of arrhythmia for 5 minutes or more or a requirement for treatment because of hemodynamic changes
NA
Article type Full-text
CABG: coronary artery bypass grafting; AF: atrial fibrillation; CA: catheter ablation; NA: not available.
10267
Int J Clin Exp Med 2015;8(7):10265-10273
Landiolol prevents atrial fibrillation after cardiac surgery
Figure 2. Risk of bias assessment.
surgery based on the data from the nine RCTs. The major analysis was focused on the preventive effect of landiolol, subgroup analysis stratified by the type of cardiac surgery was also performed and we mainly paid attention to CABG studies which were performed mostly. We also analyzed the major complications to explore the safety of landiolol. The pooled results of dichotomous outcomes were expressed as relative risks (RRs) with 95% confidence intervals (CIs). Weather fixed-effect model or random-effect model was used according to the heterogeneity. The heterogeneity across studies was tested by Q statistic (a significant level of P value
Review Article Efficacy and safety of landiolol for prevention of atrial fibrillation after cardiac surgery: a meta-analysis of randomized controlled trials Liang Li1, Qing Ai2, Ling Lin1, Pu Ge1, Changming Yang3, Li Zhang1 Departments of 1Pathophysiology, 2Physiology, Chongqing Medical University, Chongqing, China; 3Department of Anesthesiology, The First People’s Hospital of Jingmen, Jingmen, Hubei Province, China Received May 20, 2015; Accepted July 11, 2015; Epub July 15, 2015; Published July 30, 2015 Abstract: Atrial fibrillation (AF) is a quite common complication during the postoperative period after cardiac surgery. Increasing studies have reported that landiolol may be effective in prevention of AF after cardiac surgery. Its efficacy and safety are seldom explored; hence we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of landiolol in prevention of AF after cardiac surgery. Databases of PubMed, Embase and Cochrane Central Register of Controlled Trials were searched from inception through to December 2014 for RCTs that explored the efficacy and safety of landiolol on the prevention of AF after cardiac surgery. Pooled results were expressed as risk ratios (RRs) with 95% confidence intervals (CIs). Nine eligible RCTs involving 807 patients were included in this meta-analysis. Compared with the control group, landiolol was associated with a significant reduction of AF after cardiac surgery (RR=0.41; 95% CI 0.32-0.52; P60 beats/min
Full-text
Sezai et al. [24]
2012/ Japan
77/34
68.3
81.2
Intravenous landiolol perioperatively at 5 mg/kg/min for 3 days, or receiving oral bisoprolol postoperatively together with landiolol
1 week after If arrhythmia persisted for surgery more than 5 minute sor affected hemodynamics and required treatment
Full-text
Osada et al. [25]
2012/ Japan
73/68
NA
NA
No treatment and Landiolol hydrochloride 2-3 mg/ oral carvedilol kg/min was started soon after extubation after arrival in the intensive care unit after surgery and was continued for 48 hours
NA
Abstract
Nagaoka et al. [26]
2013/ Japan
22/23
65.1
78.7
Off-pump CABG
Landiolol
Diltiazem
0.5 to 2 μg/min/kg to allow evaluation of the efficacy of landiolol at an ultra-low dose
1 week after Postoperative new-onset surgery atrial fibrillation or atrial flutter requiring treatment or lasting >5 min
Full-text
Ogawa et al. [27]
2013/ Japan
68/68
70.5
77.2
Off-pump CABG
Landiolol
No treatment
Started immediately after induc1 week after AF that continued for ≥10 min tion of anesthesia, with adjustsurgery ment of the dose between 3-5 mg/kg/min to control the heart rate at 60-90 beats/min; administration continued for 2 days after the operation
Full-text
Author
Heart valve Landiolol surgery
On-pump CABG
Landiolol or landiolol Saline with oral bisoprolol
All types of Landiolol open-heart surgery
Follow-up
Definition of AF Persistence of arrhythmia for 5 minutes or more or a requirement for treatment because of hemodynamic changes
NA
Article type Full-text
CABG: coronary artery bypass grafting; AF: atrial fibrillation; CA: catheter ablation; NA: not available.
10267
Int J Clin Exp Med 2015;8(7):10265-10273
Landiolol prevents atrial fibrillation after cardiac surgery
Figure 2. Risk of bias assessment.
surgery based on the data from the nine RCTs. The major analysis was focused on the preventive effect of landiolol, subgroup analysis stratified by the type of cardiac surgery was also performed and we mainly paid attention to CABG studies which were performed mostly. We also analyzed the major complications to explore the safety of landiolol. The pooled results of dichotomous outcomes were expressed as relative risks (RRs) with 95% confidence intervals (CIs). Weather fixed-effect model or random-effect model was used according to the heterogeneity. The heterogeneity across studies was tested by Q statistic (a significant level of P value
