Vierling W
Institut für Pharmakologie und Toxikologie der TUM, München

It is long known that, after thoracic surgery, there is an increased risk for supraventricular cardiac ar­rhythmias and particular atrial fibrillation. These arrhythmias can be the basis for ventricular arrhyth­mias, embolism and stroke. In the present meta analysis, it was investigated whether there are studies which show that certain drugs can prevent the appearance of atrial fibrillation (AF), especially in pa­tients undergoing lung resection (Riber et al. Ann. Thorac. Surg. 2014, 98, 1989). In the analysis, 10 randomized, controlled investigations were selected from 161 studies. Taken together, by using several agents, a significant reduction in the risk of postoperative atrial fibrillation was found with a relative risk (RR) of 0.53 and a number needed-to-treat (NNT) of 8.5. The most effective drug was amiodarone (RR: 0.32; NNT: 4.8) followed by magnesium (RR: 0.40; NNT: 6.3). Also beta-blockers were efficient (RR: 0.43; NNT: 3.8) while calcium channel blockers were less effective (RR: 0.55; NNT: 10.4). Digoxin clearly increased the risk for AF and therefore should be avoided. Amiodarone, magnesium, beta-blockers and calcium channel blockers did not show severe adverse effects during the observation period. However, 1 trial with amiodarone was terminated earlier because of the danger to develop lung dysfunction. Calcium channel blockers induced hypotension and bradycardia which however could be managed.

The results show that amiodarone, magnesium, beta-blockers and calcium channel blockers are suited to prevent the development of AF in patients with lung resection surgery. Therefore, the authors recommend the administration of one of these compounds to prevent AF after lung surgery and here preferentially amiodarone or magnesium. In view of the fact that amiodarone principally can exert severe damage of the remaining lung tissue, it seems reasonable to prefer magnesium or beta-blockers. However, further studies are necessary to define the optimal drug and dosage for the preven­tion of AF.