Amiodarone prophylaxis for atrial fibrillation after cardiac surgery: Meta-analysis of dose response and timing of initiation

Study Objective. To investigate a possible dose-response relationship between amiodarone and reduction in incidence of postoperative atrial fibrillation, and to determine whether pre- or postoperative initiation of amiodarone is superior. Design. Meta-analysis of randomized controlled trials. Data Source. MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials for English-language reports published between 1966 and December 2005. Measurements and Main Results. Of 23 identified randomized controlled trials of amiodarone prophylaxis of postoperative atrial fibrillation, 14 were included in the final analysis. These studies enrolled a total of 2864 patients. For each study, the total administered amiodarone dose-categorized as low (<3000 mg), medium (3000-5000 mg), or high (> 5000 mg)-and preoperative versus postoperative initiation were aggregated by using meta-analytic techniques. The incidence of postoperative atrial fibrillation was significantly reduced by amiodarone compared with placebo (p