In a recent publication in the BMJ , Norhayati et al conducted a systematic review and meta-analysis aimed to investigate metoprolol compared with other treatments for prophylaxis against postoperative atrial fibrillation (POAF), which is a possibly fatal and morbid complication after open heart surgery. In the review, Norhayati searched CENTRAL, MEDLINE, EMBASE, and trial registries for randomized, controlled trials that evaluated metoprolol for averting the incidence of POAF after surgery against other treatments or placebo.

A random-effects model was utilized for assessing the risk ratios (RRs) and mean disparities with 95% confidence intervals (CIs). They found that nine trials involving 1,570 patients demonstrated that metoprolol diminished POAF compared with placebo (416 patients; RR 0.46, 95% CI, 0.33-0.66; I2 = 21%; risk difference (RD) –0.19, 95% CI, –0.28 to –0.10). However, metoprolol expanded the risk of POAF compared with carvedilol (159 patients; RR 1.59, 95% CI, 1.20-2.12; I2 = 4%; RD 0.13, 95% CI, 0.06-0.20).

There was no variation compared with sotalol or amiodarone. The incidence of cardiovascular conditions after drug administration or death between the groups was not different, and the overall quality of evidence was moderate to high. Subgroup analysis and funnel plot were not performed.

The researchers concluded that metoprolol is effective in preventing POAF compared with placebo and indicated no difference with class III antiarrhythmic drugs. They also concluded that mortality and thromboembolism are correlated with open heart surgery, but not substantial in relation to the use of metoprolol.
 
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