Meta-analysis of Randomized Controlled Trials on the Efficacy of Thoracic Epidural Anesthesia in Preventing Atrial Fibrillation After Coronary Artery Bypass Grafting

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2012 Aug 21

PMID 22900930

Citations 1

Authors

Wan-Jie Gu

Chun-Yin Wei

De-Qing Huang

Rui-Xing Yin

Affiliations

Soon will be listed here.

Abstract

Background: Postoperative atrial fibrillation (POAF) is one of the most common complications in patients undergoing coronary artery bypass grafting (CABG). The goal of this meta-analysis was to evaluate the efficacy of thoracic epidural anesthesia (TEA) in preventing POAF in adult patients undergoing CABG.

Methods: MEDLINE and EMBASE were searched to identify randomized controlled trails in adult patients undergoing CABG who were randomly assigned to receive general anesthesia plus thoracic epidural anesthesia (GA + TEA) or general anesthesia only (GA). Two authors independently extracted data using a standardized Excel file. The primary outcome measure was the incidence of POAF. We used DerSimonian-Laird random-effects models to compute summary risk ratios with 95% confidence intervals.

Results: Five studies involving 540 patients met our inclusion criteria. No significant difference in the incidence of POAF was observed between the two groups (risk ratio, 0.61; 95% confidence interval, 0.33 to 1.12; P = 0.11), with significant heterogeneity among the studies (I2 = 73%, P = 0.005). Sensitivity analyses by primary endpoint, methodological quality and surgical technique yielded similar results.

Conclusions: The limited evidence suggests that TEA shows no beneficial efficacy in preventing POAF in adult patients undergoing CABG. However, the results of this meta-analysis should be interpreted with caution due to significant heterogeneity of the studies included. Thus, the potential infuence of TEA on the incidence of atrial fibrillation following CABG warrants further investigation.

Citing Articles

Antiarrhythmic Mechanisms of Epidural Blockade After Myocardial Infarction.

Hoang J, van Weperen V, Kang K, Jani N, Swid M, Chan C Circ Res. 2024; 135(3):e57-e75.

PMID: 38939925 PMC: 11257785. DOI: 10.1161/CIRCRESAHA.123.324058.

References

Scott N, Turfrey D, Ray D, Nzewi O, Sutcliffe N, Lal A . A prospective randomized study of the potential benefits of thoracic epidural anesthesia and analgesia in patients undergoing coronary artery bypass grafting. Anesth Analg. 2001; 93(3):528-35. DOI: 10.1097/00000539-200109000-00003. View

de Vries A, Mariani M, van der Maaten J, Loef B, Lip H . To ventilate or not after minimally invasive direct coronary artery bypass surgery: the role of epidural anesthesia. J Cardiothorac Vasc Anesth. 2002; 16(1):21-6. DOI: 10.1053/jcan.2002.29645. View

Mauldin P, Weintraub W, BECKER E . Predicting hospital costs for first-time coronary artery bypass grafting from preoperative and postoperative variables. Am J Cardiol. 1994; 74(8):772-5. DOI: 10.1016/0002-9149(94)90432-4. View

Aranki S, Shaw D, Adams D, Rizzo R, Couper G, VanderVliet M . Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. 1996; 94(3):390-7. DOI: 10.1161/01.cir.94.3.390. View

Fillinger M, Yeager M, Dodds T, Fillinger M, Whalen P, Glass D . Epidural anesthesia and analgesia: effects on recovery from cardiac surgery. J Cardiothorac Vasc Anesth. 2002; 16(1):15-20. DOI: 10.1053/jcan.2002.29639. View

Ho A, Chung D, Joynt G . Neuraxial blockade and hematoma in cardiac surgery: estimating the risk of a rare adverse event that has not (yet) occurred. Chest. 2000; 117(2):551-5. DOI: 10.1378/chest.117.2.551. View

Wijeysundera D, Bender J, Beattie W . Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. Cochrane Database Syst Rev. 2009; (4):CD004126. DOI: 10.1002/14651858.CD004126.pub2. View

Priestley M, Cope L, Halliwell R, Gibson P, Chard R, Skinner M . Thoracic epidural anesthesia for cardiac surgery: the effects on tracheal intubation time and length of hospital stay. Anesth Analg. 2002; 94(2):275-82, table of contents. DOI: 10.1097/00000539-200202000-00009. View

Burgess D, Kilborn M, Keech A . Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur Heart J. 2006; 27(23):2846-57. DOI: 10.1093/eurheartj/ehl272. View

10.

Echahidi N, Pibarot P, OHara G, Mathieu P . Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol. 2008; 51(8):793-801. DOI: 10.1016/j.jacc.2007.10.043. View

11.

Kjaergard L, Villumsen J, Gluud C . Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med. 2001; 135(11):982-9. DOI: 10.7326/0003-4819-135-11-200112040-00010. View

12.

Panesar S, Athanasiou T, Nair S, Rao C, Jones C, Nicolaou M . Early outcomes in the elderly: a meta-analysis of 4921 patients undergoing coronary artery bypass grafting--comparison between off-pump and on-pump techniques. Heart. 2006; 92(12):1808-16. PMC: 1861313. DOI: 10.1136/hrt.2006.088450. View

13.

Barrington M, Kluger R, Watson R, Scott D, Harris K . Epidural anesthesia for coronary artery bypass surgery compared with general anesthesia alone does not reduce biochemical markers of myocardial damage. Anesth Analg. 2005; 100(4):921-928. DOI: 10.1213/01.ANE.0000146437.88485.47. View

14.

Begg C, Mazumdar M . Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50(4):1088-101. View

15.

Jadad A, Moore R, Carroll D, Jenkinson C, Reynolds D, Gavaghan D . Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials. 1996; 17(1):1-12. DOI: 10.1016/0197-2456(95)00134-4. View

16.

Svircevic V, van Dijk D, Nierich A, Passier M, Kalkman C, van der Heijden G . Meta-analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery. Anesthesiology. 2011; 114(2):271-82. DOI: 10.1097/ALN.0b013e318201d300. View

17.

Jideus L, Joachimsson P, Stridsberg M, Ericson M, Tyden H, Nilsson L . Thoracic epidural anesthesia does not influence the occurrence of postoperative sustained atrial fibrillation. Ann Thorac Surg. 2001; 72(1):65-71. DOI: 10.1016/s0003-4975(01)02631-5. View

18.

Tenenbein P, Debrouwere R, Maguire D, Duke P, Muirhead B, Enns J . Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery. Can J Anaesth. 2008; 55(6):344-50. DOI: 10.1007/BF03021489. View

19.

Kalman J, Munawar M, Howes L, Louis W, Buxton B, Gutteridge G . Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg. 1995; 60(6):1709-15. DOI: 10.1016/0003-4975(95)00718-0. View

20.

Zaman A, Archbold R, Helft G, Paul E, Curzen N, Mills P . Atrial fibrillation after coronary artery bypass surgery: a model for preoperative risk stratification. Circulation. 2000; 101(12):1403-8. DOI: 10.1161/01.cir.101.12.1403. View