https://doi.org/10.4081/cardio.2024.51
Carvedilol versus metoprolol in preventing post-operative atrial fibrillation: a systematic review and meta-analysis
Published: December 30, 2024
Abstract Views: 189
pdf: 38
Appendix A: 50
Appendix B: 64
Appendix A: 50
Appendix B: 64
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Background: The American Heart Association suggests considering amiodarone, sotalol, and/or β-blockers for the prevention of postoperative atrial fibrillation (POAF). However, managing POAF remains an area of uncertainty despite its high incidence and potential severity. While β-blockers are generally effective, their efficacy can vary due to class-related differences. We aim to conduct a systematic review and meta-analysis comparing two recommended β-blockers for the prevention of POAF.
Methods: We searched PubMed/Medline, EMBASE, Web of Science, Scopus, and Cochrane Central for studies comparing metoprolol and carvedilol in the prevention of POAF in patients undergoing CABG. Primary outcome was to compare the incidence of POAF in two groups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the ID: CRD42023469364.
Results: This meta-analysis included 691 patients across four clinical trials. The mean age of participants ranged from 5 ±10 to 63±9 years. Carvedilol was associated with a significantly lower incidence of POAF compared to metoprolol (RR: 0.628; 95% CI: 0.473-0.834, p<0.001). Risk difference analysis demonstrated a 13.95% absolute reduction in POAF with carvedilol (RD: -0.1395; 95% CI: -0.2 to -0.06). There were no significant differences between the groups in mortality (0.3% vs 0.7%), stroke (0% vs 0.3%), MI (0.3% vs 0.3%), or bradycardia (2.9% vs 3.3%) (all p>0.05).
Conclusion: Carvedilol proves more effective than metoprolol in preventing POAF in CABG patients. Furthermore, patients on both β-blockers showed minimal mortality, low perioperative myocardial infarction, rare bradycardia incidents, and an infrequent need for electrical cardioversion.
1. Kirklin JK, Blackstone EH. Kirklin/Barratt-Boyes cardiac surgery. Philadelphia, Elsevier Saunders; 2012.
2. Lubitz SA, Yin X, Rienstra M, et al. Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study. Circulation 2015;131:1648-55.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.014058
3. Park TJ, Hansen R, Gillard P, et al. Healthcare resource utilization and costs for patients with postoperative atrial fibrillation in the United States. J Med Econ 2023;26:1417-23.
DOI: https://doi.org/10.1080/13696998.2023.2267390
4. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014;130:2071-104.
DOI: https://doi.org/10.1161/CIR.0000000000000040
5. Skaria R, Parvaneh S, Zhou S, et al. Path to precision: prevention of post-operative atrial fibrillation. J Thorac Dis 2020;12:2735-46.
DOI: https://doi.org/10.21037/jtd-19-3875
6. Dobrev D, Aguilar M, Heijman J, et al. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol 2019;16:417-36.
DOI: https://doi.org/10.1038/s41569-019-0166-5
7. Celik T, Iyisoy A, Jata B, et al. Beta blockers for the prevention of atrial fibrillation after coronary artery bypass surgery: Carvedilol versus metoprolol. Int J Cardiol 2009;135:393-6.
DOI: https://doi.org/10.1016/j.ijcard.2007.12.026
8. Stone KH, Reynolds K, Davis S, et al. Comparison of new-onset post-operative atrial fibrillation between patients receiving carvedilol and metoprolol after off-pump coronary artery bypass graft surgery. Gen Thorac Cardiovasc Surg 2023;71:299-305.
DOI: https://doi.org/10.1007/s11748-022-01877-5
9. Jalalian R, Ghafari R, Ghazanfari P. Comparing the therapeutic effects of carvedilol and metoprolol on prevention of atrial fibrillation after coronary artery bypass surgery, a double-blind study. Int Cardiovasc Res J 2014;8:111.
10. Higgins JPT TJ, Chandler J, Cumpston M, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook
11. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 2021;88:105906.
DOI: https://doi.org/10.1016/j.ijsu.2021.105906
12. Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
DOI: https://doi.org/10.1136/bmj.d5928
13. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088-101.
DOI: https://doi.org/10.2307/2533446
14. Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000;56:455-63.
DOI: https://doi.org/10.1111/j.0006-341X.2000.00455.x
15. Sterne JA, Sutton AJ, Ioannidis JP, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 2011;343:d4002.
DOI: https://doi.org/10.1136/bmj.d4002
16. Acikel S, Bozbas H, Aydinalp A, et al. Comparision of the efficacy of metoprolol and carvedilol for the prevention of atrial fibrillation undergoing coronary bypass surgery. Eur Heart J 2005;26:18-9.
17. Haghjoo M, Saravi M, Hashemi MJ, et al. Optimal beta-blocker for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery: carvedilol versus metoprolol. Heart Rhythm 2007;4:1170-4.
DOI: https://doi.org/10.1016/j.hrthm.2007.04.022
18. Ozaydin M, Peker O, Erdogan D, et al. Oxidative status, inflammation, and postoperative atrial fibrillation with metoprolol vs carvedilol or carvedilol plus n-acetyl cysteine treatment. Clin Cardiol 2014;37:300-6.
DOI: https://doi.org/10.1002/clc.22249
19. Jalalian R, Ghafari R, Ghazanfari P. Comparing the therapeutic effects of carvedilol and metoprolol on prevention of atrial fibrillation after coronary artery bypass surgery, a double-blind study. Int Cardiovasc Res J 2014;8:111-5.
20. White CM, Giri S, Tsikouris JP, et al. A comparison of two individual amiodarone regimens to placebo in open heart surgery patients. Ann Thorac Surg 2002;74:69-74.
DOI: https://doi.org/10.1016/S0003-4975(02)03593-2
21. Saçar M, Önem G, Emrecan B, Verdi D. Carvedilol is more effective than metoprolol in preventing the atrial fibrillation seen after coronary artery bypass surgery. Kofluyolu Heart J 2009;12:18-24.
22. Taylor GJ, Malik SA, Colliver JA, et al. Usefulness of atrial fibrillation as a predictor of stroke after isolated coronary artery bypass grafting. Am J Cardiol 1987;60:905-7.
DOI: https://doi.org/10.1016/0002-9149(87)91045-9
23. Korantzopoulos P, Kolettis TM, Galaris D, Goudevenos JA. The role of oxidative stress in the pathogenesis and perpetuation of atrial fibrillation. Int J Cardiol 2007;115:135-43.
DOI: https://doi.org/10.1016/j.ijcard.2006.04.026
24. Mihm MJ, Yu F, Carnes CA, et al. Impaired myofibrillar energetics and oxidative injury during human atrial fibrillation. Circulation 2001;104:174-80.
DOI: https://doi.org/10.1161/01.CIR.104.2.174
25. Maggi E, Marchesi E, Covini D, et al. Protective effects of carvedilol, a vasodilating beta-adrenoceptor blocker, against in vivo low density lipoprotein oxidation in essential hypertension. J Cardiovasc Pharmacol 1996;27:532-8.
DOI: https://doi.org/10.1097/00005344-199604000-00012
26. DiNicolantonio JJ, Beavers CJ, Menezes AR, et al. Meta-analysis comparing carvedilol versus metoprolol for the prevention of postoperative atrial fibrillation following coronary artery bypass grafting. Am J Cardiol 2014;113:565-9.
DOI: https://doi.org/10.1016/j.amjcard.2013.10.020
27. Zakkar M, Ascione R, James AF, et al. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 2015;154:13-20.
DOI: https://doi.org/10.1016/j.pharmthera.2015.06.009
28. Yasunari K, Maeda K, Nakamura M, et al. Effects of carvedilol on oxidative stress in polymorphonuclear and mononuclear cells in patients with essential hypertension. Am J Med 2004;116:460-5.
DOI: https://doi.org/10.1016/j.amjmed.2003.10.029
29. Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med 2001;135:1061-73.
DOI: https://doi.org/10.7326/0003-4819-135-12-200112180-00010
30. Ferro CR, Oliveira DC, Nunes FP, Piegas LS. Postoperative atrial fibrillation after cardiac surgery. Arq Bras Cardiol 2009;93:59-63.
DOI: https://doi.org/10.1590/S0066-782X2009000700011
31. Maesen B, Nijs J, Maessen J, Allessie M, Schotten U. Post-operative atrial fibrillation: a maze of mechanisms. Europace 2012;14:159-74.
DOI: https://doi.org/10.1093/europace/eur208
32. Mostafa A, El-Haddad MA, Shenoy M, Tuliani T. Atrial fibrillation post cardiac bypass surgery. Avicenna J Med 2012;2:65-70.
DOI: https://doi.org/10.4103/2231-0770.102280
33. Macedo MP, Lautt WW. Shear-induced modulation by nitric oxide of sympathetic nerves in the superior mesenteric artery. Can J Physiol Pharmacol 1996;74:692-700.
DOI: https://doi.org/10.1139/y96-055
34. Macedo MP, Lautt WW. Shear-induced modulation of vasoconstriction in the hepatic artery and portal vein by nitric oxide. Am J Physiol 1998;274:G253-60.
DOI: https://doi.org/10.1152/ajpgi.1998.274.2.G253
35. Torp-Pedersen C, Poole-Wilson PA, Swedberg K, et al. Effects of metoprolol and carvedilol on cause-specific mortality and morbidity in patients with chronic heart failure--COMET. Am Heart J 2005;149:370-6.
DOI: https://doi.org/10.1016/j.ahj.2004.10.002
36. Remme WJ, Cleland JG, Erhardt L, et al. Effect of carvedilol and metoprolol on the mode of death in patients with heart failure. Eur J Heart Fail 2007;9:1128-35.
DOI: https://doi.org/10.1016/j.ejheart.2007.07.014
37. Savitz SI, Erhardt JA, Anthony JV, et al. The novel beta-blocker, carvedilol, provides neuroprotection in transient focal stroke. J Cereb Blood Flow Metab 2000;20:1197-204.
DOI: https://doi.org/10.1097/00004647-200008000-00005
38. Otterstad JE, Ford I. The effect of carvedilol in patients with impaired left ventricular systolic function following an acute myocardial infarction. How do the treatment effects on total mortality and recurrent myocardial infarction in CAPRICORN compare with previous beta-blocker trials? Eur J Heart Fail 2002;4:501-6.
DOI: https://doi.org/10.1016/S1388-9842(02)00099-5
39. Shin J, Pletcher MJ. Risk of emergent bradycardia associated with the use of carvedilol and metoprolol in routine clinical practice. Am J Med 2013;126:805-10 e5.
DOI: https://doi.org/10.1016/j.amjmed.2013.02.030
40. Poole-Wilson PA, Swedberg K, Cleland JG, et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet 2003;362:7-13.
DOI: https://doi.org/10.1016/S0140-6736(03)13800-7
41. Bakris GL, Fonseca V, Katholi RE, et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA 2004;292:2227-36.
DOI: https://doi.org/10.1001/jama.292.18.2227
How to Cite
Askarinejad, A., Kohansal, E., Ardestani, S. S., Mozafarybazargany, M., Hesami, H., Sabahizadeh, A., … Haghjoo, M. (2024). Carvedilol <i>versus</i> metoprolol in preventing post-operative atrial fibrillation: a systematic review and meta-analysis. Global Cardiology, 2(4). https://doi.org/10.4081/cardio.2024.51
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Ralph Stephan von Bardeleben, Muhammad Shahzeb Khan, Martin Geyer, Tim Friede, Javed Butler, Monika Diek, Jutta Heinrich, Marius Placzek, Roberto Ferrari, William T. Abraham, Ottavio Alfieri, Angelo Auricchio, Antoni Bayes-Genis, John G.F. Cleland, Gerasimos Filippatos, Finn Gustafsson, Wilhelm Haverkamp, Malte Kelm, Karl-Heinz Kuck, Ulf Landmesser, Aldo P. Maggioni, Marco Metra, Vlasis Ninios, Mark C. Petrie, Tienush Rassaf, Frank Ruschitzka, Ulrich Schäfer, P. Christian Schulze, Konstantinos Spargias, Alec Vahanian, Jose Luis Zamorano, Andreas Zeiher, Mahir Karakas, Friedrich Koehler, Mitja Lainscak, Alper Öner, Nikolaos Mezilis, Efstratios K. Theofilogiannakos, Ilias Ninios, Michael Chrissoheris, Panagiota Kourkoveli, Konstantinos Papadopoulos, Grzegorz Smolka, Wojciech Wojakowski, Krzysztof Reczuch, Fausto J. Pinto, Łukasz Wiewiórka, Zbigniew Kalarus, Marianna Adamo, Evelyn Santiago-Vacas, Tobias Friedrich Ruf, Michael Gross, Joern Tongers, Gerd Hasenfuß, Wolfgang Schillinger, Piotr Ponikowski, Stefan D. Anker, Baseline echocardiographic characteristics of patients enrolled in the randomized investigation of MitraClip device in heart failure (RESHAPE HF-2) trial: comparison with COAPT and Mitra-FR , Global Cardiology: Vol. 2 No. 2 (2024)
- Javed Butler, Sanjiv J. Shah, Melissa Magwire, Carlos Campos, Muhammad Shariq Usman, Anthony Hoovler, Anup Sabharwal, Barry A. Borlaug, Treatment pathways in patients with heart failure with preserved ejection fraction and obesity: perspectives from cardiology specialists and patients , Global Cardiology: Vol. 2 No. 2 (2024)
- Kamilu M. Karaye, Idris Y. Mohammed, Hadiza Sa’idu, Naser A. Ishaq, Suleiman A. Balarabe, Jamilu Tukur, Tewogbade A. Adedeji, Olufemiwa N. Makinde, Rasaaq A. Adebayo, Prevalence of left ventricular dysfunction and relationship with serum selenium in apparently healthy pregnant women: results from the PEACE registry , Global Cardiology: Vol. 2 No. 2 (2024)
- Camila Bedo, Juan C. Grignola, Preferential vasodilator effects of levosimendan in resistance pulmonary arteries in a rodent pulmonary embolism model , Global Cardiology: Vol. 2 No. 1 (2024)
You may also start an advanced similarity search for this article.
