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Prophylactic Role of Beta Blockers in New-Onset Atrial Fibrillation After Cardiac Surgery. A Systematic Review and Meta-Analysis
S27
Abstracts
Spencer Heald 1, Rose Allan 1, Irene Gray 1, Martin K Stiles 1* 1
Waikato District Health Board, Hamilton, New Zealand Bay of Plenty District Health Board, Tauranga, New Zealand 3 Capital and Coast District Health Board, Wellington, New Zealand * Corresponding author. 2
Aim: Pulmonary vein isolation for symptomatic atrial fibrillation (AF) using cryoablation is a well-established treatment in the Midland region of New Zealand since November 2012. The incidence of AF increases with age; we set out to determine how successful this therapy is with older patients. In this retrospective study, we analysed 1-year success of cryoablation for AF in patients 65 years and compared this group with patients <65y. Method: In the period from April 2013 until February 2016, 215 patients presenting with symptomatic paroxysmal (PAF) or persistent AF (PeAF) who underwent cryoablation (2nd generation balloon) were included in this retrospective study. Results: For the 65y group (mean 68.7 + /-3.2, range 6579y) a total of 66 patients with PAF (n = 33) or PeAF (n = 3) were included. In comparison 134 PAF and 15 PeAF patients had cryoablation aged <65y. At 12 months for those 65y, 41/66 patients (62%) were free of AF (off drugs) with another 9/66 (14%) free of AF on anti-arrhythmic therapy. At 12 months for <65y (mean 53.4+/-8.4, range 22-64y) 97/149 (65%) had no AF (off drugs) with 12/149 (8%) on medication. Complications and mortality did not differ between the two groups. Conclusion: Pulmonary vein isolation for AF using cryoablation appears equally effective for patients over the age of 65 years as for younger patients. Success rate at 1 year for 65y is 76% (+/- drugs) compared to 73% for <65y. http://dx.doi.org/10.1016/j.hlc.2017.05.068 P34 Prophylactic Role of Beta Blockers in New-Onset Atrial Fibrillation After Cardiac Surgery. A Systematic Review and Meta-Analysis Paul Thein 1*, Kyle White 2, Khyati Banker 2, Carole Lunny 4, Sam Mirzaee 3, Arthur Nasis 3 1
Monash Medical Centre, Monash Health, Clayton, Australia 2 Monash University, Melbourne, Australia 3 Monash Heart, Monash Medical Centre, Monash Health, Melbourne, Australia 4 Cochrane Australia, Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia * Corresponding author. Background: Current epidemiological data suggests that postoperative atrial fibrillation or atrial flutter (POAF) causes significant morbidity and mortality after cardiac surgery. The literature for prophylactic management of POAF is limited,
resulting in lack of clear guideline management recommendations. Aim: To examine the efficacy of prophylactic rate control agents in reducing the incidence of new-onset POAF in patients undergoing elective cardiac surgery. Methods: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and MEDLINE were systematically searched for blinded randomised controlled studies (RCT) evaluating adults with no history of atrial fibrillation randomised to a pharmacological agent (either beta blocker, calcium channel blocker or digoxin), compared to placebo. Utilising Cochrane guidance, three reviewers screened, extracted and assessed the quality of the evidence. We used a random effects meta-analysis to compare a rate-control agent with placebo. Results: Five RCTs (688 subjects, mean age 61 8.9, 69% male) were included. Beta blocker administration prior to elective cardiac surgery significantly reduced the incidence of POAF (OR 0.43,95%Cl [0.30, 0.61], I2 = 0%) without significant impact on ischaemic stroke (OR 0.49, 95%Cl [0.10, 2.44], I2 = 0%), non-fatal myocardial infarction (OR 0.76, 95%Cl [0.08-7.44]), overall mortality (OR 0.83, 95%Cl [0.19-3.66], I2 = 0%), or length of stay -0.96 days (95%Cl -1.49 to -0.42, I2 = 0%). An increased rate of bradycardic episodes was observed (OR 3.53, 95%Cl [1.22- 10.23], I2 = 0%). Conclusion: This review suggests that selective administration of prophylactic oral beta blockers prior to elective cardiac surgery is safe and may reduce the incidence of POAF. http://dx.doi.org/10.1016/j.hlc.2017.05.069 P35 Predictors and Risk Scores for New Atrial Fibrillation After Coronary Artery Bypass Grafting Tom Kai Ming Wang *, Yi-Wen (Becky) Liao, Tharumenthiran Ramanathan Auckland City Hospital, Auckland, New Zealand Corresponding author.
*
Background: New atrial fibrillation (AF) is a common complication after cardiac surgery, and is associated with increased length of hospital stay, morbidity and mortality. Identifying high risk patients may allow a targeted approach to preventing new AF. We evaluated the risk factors of and performance of risk models at predicting new AF after coronary artery bypass grafting (CABG). Methods: All patients without preoperative AF undergoing isolated CABG at Auckland City Hospital from July 2010June 2012 were included. The prognostic utility of the AF risk index by El-Chami et al., 2012, CHADS2, CHA2DS2-VASc, EuroSCOREs and STS Score for new AF after CABG was assessed. Results: There were 757 (of 818) CABG patients without preoperative AF, mean age 64.0+/-10.0 years and 157 (20.7%) females. Postoperative AF occurred in 179 (23.7%), and was associated with prolonged intensive care (p = 0.012) and hospital stay postoperatively (p < 0.001). Independent predictors of new AF included increased age, weight, congestive
Abstracts
Spencer Heald 1, Rose Allan 1, Irene Gray 1, Martin K Stiles 1* 1
Waikato District Health Board, Hamilton, New Zealand Bay of Plenty District Health Board, Tauranga, New Zealand 3 Capital and Coast District Health Board, Wellington, New Zealand * Corresponding author. 2
Aim: Pulmonary vein isolation for symptomatic atrial fibrillation (AF) using cryoablation is a well-established treatment in the Midland region of New Zealand since November 2012. The incidence of AF increases with age; we set out to determine how successful this therapy is with older patients. In this retrospective study, we analysed 1-year success of cryoablation for AF in patients 65 years and compared this group with patients <65y. Method: In the period from April 2013 until February 2016, 215 patients presenting with symptomatic paroxysmal (PAF) or persistent AF (PeAF) who underwent cryoablation (2nd generation balloon) were included in this retrospective study. Results: For the 65y group (mean 68.7 + /-3.2, range 6579y) a total of 66 patients with PAF (n = 33) or PeAF (n = 3) were included. In comparison 134 PAF and 15 PeAF patients had cryoablation aged <65y. At 12 months for those 65y, 41/66 patients (62%) were free of AF (off drugs) with another 9/66 (14%) free of AF on anti-arrhythmic therapy. At 12 months for <65y (mean 53.4+/-8.4, range 22-64y) 97/149 (65%) had no AF (off drugs) with 12/149 (8%) on medication. Complications and mortality did not differ between the two groups. Conclusion: Pulmonary vein isolation for AF using cryoablation appears equally effective for patients over the age of 65 years as for younger patients. Success rate at 1 year for 65y is 76% (+/- drugs) compared to 73% for <65y. http://dx.doi.org/10.1016/j.hlc.2017.05.068 P34 Prophylactic Role of Beta Blockers in New-Onset Atrial Fibrillation After Cardiac Surgery. A Systematic Review and Meta-Analysis Paul Thein 1*, Kyle White 2, Khyati Banker 2, Carole Lunny 4, Sam Mirzaee 3, Arthur Nasis 3 1
Monash Medical Centre, Monash Health, Clayton, Australia 2 Monash University, Melbourne, Australia 3 Monash Heart, Monash Medical Centre, Monash Health, Melbourne, Australia 4 Cochrane Australia, Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia * Corresponding author. Background: Current epidemiological data suggests that postoperative atrial fibrillation or atrial flutter (POAF) causes significant morbidity and mortality after cardiac surgery. The literature for prophylactic management of POAF is limited,
resulting in lack of clear guideline management recommendations. Aim: To examine the efficacy of prophylactic rate control agents in reducing the incidence of new-onset POAF in patients undergoing elective cardiac surgery. Methods: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and MEDLINE were systematically searched for blinded randomised controlled studies (RCT) evaluating adults with no history of atrial fibrillation randomised to a pharmacological agent (either beta blocker, calcium channel blocker or digoxin), compared to placebo. Utilising Cochrane guidance, three reviewers screened, extracted and assessed the quality of the evidence. We used a random effects meta-analysis to compare a rate-control agent with placebo. Results: Five RCTs (688 subjects, mean age 61 8.9, 69% male) were included. Beta blocker administration prior to elective cardiac surgery significantly reduced the incidence of POAF (OR 0.43,95%Cl [0.30, 0.61], I2 = 0%) without significant impact on ischaemic stroke (OR 0.49, 95%Cl [0.10, 2.44], I2 = 0%), non-fatal myocardial infarction (OR 0.76, 95%Cl [0.08-7.44]), overall mortality (OR 0.83, 95%Cl [0.19-3.66], I2 = 0%), or length of stay -0.96 days (95%Cl -1.49 to -0.42, I2 = 0%). An increased rate of bradycardic episodes was observed (OR 3.53, 95%Cl [1.22- 10.23], I2 = 0%). Conclusion: This review suggests that selective administration of prophylactic oral beta blockers prior to elective cardiac surgery is safe and may reduce the incidence of POAF. http://dx.doi.org/10.1016/j.hlc.2017.05.069 P35 Predictors and Risk Scores for New Atrial Fibrillation After Coronary Artery Bypass Grafting Tom Kai Ming Wang *, Yi-Wen (Becky) Liao, Tharumenthiran Ramanathan Auckland City Hospital, Auckland, New Zealand Corresponding author.
*
Background: New atrial fibrillation (AF) is a common complication after cardiac surgery, and is associated with increased length of hospital stay, morbidity and mortality. Identifying high risk patients may allow a targeted approach to preventing new AF. We evaluated the risk factors of and performance of risk models at predicting new AF after coronary artery bypass grafting (CABG). Methods: All patients without preoperative AF undergoing isolated CABG at Auckland City Hospital from July 2010June 2012 were included. The prognostic utility of the AF risk index by El-Chami et al., 2012, CHADS2, CHA2DS2-VASc, EuroSCOREs and STS Score for new AF after CABG was assessed. Results: There were 757 (of 818) CABG patients without preoperative AF, mean age 64.0+/-10.0 years and 157 (20.7%) females. Postoperative AF occurred in 179 (23.7%), and was associated with prolonged intensive care (p = 0.012) and hospital stay postoperatively (p < 0.001). Independent predictors of new AF included increased age, weight, congestive