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lüll Carvedilol for prevention of atrial fibrillation after cardiac surgery: a meta-analysis Wang HS; Wang ZW; Yin ZTPLoS One 2014[]; 9 (4): e94005BACKGROUND: Postoperative atrial fibrillation (POAF) remains the most common complication after cardiac surgery. Current guidelines recommend beta-blockers to prevent POAF. Carvedilol is a non-selective beta-adrenergic blocker with anti-inflammatory, antioxidant, and multiple cationic channel blocking properties. These unique properties of carvedilol have generated interest in its use as a prophylaxis for POAF. OBJECTIVE: To investigate the efficacy of carvedilol in preventing POAF. METHODS: PubMed from the inception to September 2013 was searched for studies assessing the effect of carvedilol on POAF occurrence. Pooled relative risk (RR) with 95% confidence interval (CI) was calculated using random- or fixed-effect models when appropriate. Six comparative trials (three randomized controlled trials and three nonrandomized controlled trials) including 765 participants met the inclusion criteria. RESULTS: Carvedilol was associated with a significant reduction in POAF (relative risk [RR] 0.49, 95% confidence interval [CI] 0.37 to 0.64, p<0.001). Subgroup analyses yielded similar results. In a subgroup analysis, carvedilol appeared to be superior to metoprolol for the prevention of POAF (RR 0.51, 95% CI 0.37 to 0.70, p<0.001). No evidence of heterogeneity was observed. CONCLUSIONS: In conclusion, carvedilol may effectively reduce the incidence of POAF in patients undergoing cardiac surgery. It appeared to be superior to metoprolol. A large-scale, well-designed randomized controlled trial is needed to conclusively answer the question regarding the utility of carvedilol in the prevention of POAF.|*Chemoprevention[MESH]|Adrenergic beta-Antagonists/*therapeutic use[MESH]|Atrial Fibrillation/epidemiology/*etiology/*prevention & control[MESH]|Carbazoles/*therapeutic use[MESH]|Cardiac Surgical Procedures/*adverse effects[MESH]|Carvedilol[MESH]|Clinical Trials as Topic[MESH]|Humans[MESH]|Incidence[MESH]|Odds Ratio[MESH]|Postoperative Complications/epidemiology/*prevention & control[MESH]|Propanolamines/*therapeutic use[MESH]|Publication Bias[MESH]|Treatment Outcome[MESH] |