Nicholas Z. Kerin, MD, Sony Jacob, MD The American Journal of Medicine

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Presentation transcript:

The Efficacy of Sotalol in Preventing Postoperative Atrial Fibrillation: A Meta-Analysis Nicholas Z. Kerin, MD, Sony Jacob, MD The American Journal of Medicine Volume 124, Issue 9, Pages 875.e1-875.e9 (September 2011) DOI: 10.1016/j.amjmed.2011.04.025 Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 1 Flow chart of study selection shows the search strategy used with PubMed. The systematic review resulted in 15 eligible studies; 6 were double-blind and 9 were open-label. The American Journal of Medicine 2011 124, 875.e1-875.e9DOI: (10.1016/j.amjmed.2011.04.025) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 2 RR of developing supraventricular tachyarrhythmia after cardiac surgery: sotalol versus placebo. Each row shows the name of the first author of the publication followed by the reference number in parentheses, the RR of developing supraventricular tachyarrhythmia with 95% CI, and the significance (P) of the difference in risks. The number of patients who developed supraventricular tachyarrhythmia and the total number of the patients (event/total) in the sotalol and placebo arms also are shown for each study. The graphic presentations of the results are shown on the right (Forrest plot). The boxes represent the RR, and the lines represent the 95% CI for individual studies. The size of boxes and thickness of lines reflect the weight of a study in the analysis. The result of the meta-analysis is shown in the last row (bottom) numerically and graphically (the diamond in the Forest plot). Test for heterogeneity: I2 is the percentage of total variation in study estimates that is due to heterogeneity of 0%. Thus, the studies were homogeneous. The Mantel-Haenszel fixed-effect model was used for the meta-analysis. The combined (weighted mean) RR was 0.550 (95% CI, 0.454-0.667), indicating a significantly lower risk of developing supraventricular tachyarrhythmia on sotalol than on placebo (P<.001). CI=confidence interval. The American Journal of Medicine 2011 124, 875.e1-875.e9DOI: (10.1016/j.amjmed.2011.04.025) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 3 RR of developing supraventricular tachyarrhythmia after cardiac surgery: sotalol versus no treatment. The studies and data elements are organized as in Figure 2. The studies were homogeneous (I2=0%). The Mantel-Haenszel fixed-effect model was used for meta-analysis. The combined (weighted mean) RR was 0.329 (95% CI, 0.236-0.459), indicating a significantly lower risk of developing supraventricular tachyarrhythmia on sotalol treatment than on no treatment (P<.001). CI=confidence interval. The American Journal of Medicine 2011 124, 875.e1-875.e9DOI: (10.1016/j.amjmed.2011.04.025) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 4 RR of developing supraventricular tachyarrhythmias after cardiac surgery: sotalol versus beta-adrenergic receptor blocking agents. The studies and data elements are organized as in Figure 2. The studies were homogeneous (I2=0%). The Mantel-Haenszel fixed-effect model was used for meta-analysis. The combined (weighted mean) RR was 0.644 (95% CI, 0.495-0.838), indicating a significantly lower risk of developing supraventricular tachyarrhythmia on sotalol than on beta-blockers (P<.001). CI=confidence interval. The American Journal of Medicine 2011 124, 875.e1-875.e9DOI: (10.1016/j.amjmed.2011.04.025) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 5 Length of hospital stay: sotalol versus placebo. Four randomized, placebo-controlled, double-bind trials provided data on the length of hospital stay. Each showed a nonsignificant trend toward shorter hospital stay on sotalol. The studies were homogenous (I2=0%); therefore, the Mantel-Haenszel fixed-effect model was used for meta-analysis. The combined (weighted) standardized mean difference indicates that the length of hospital stay was significantly shorter on sotalol than on placebo (P<.5). CI=confidence interval. The American Journal of Medicine 2011 124, 875.e1-875.e9DOI: (10.1016/j.amjmed.2011.04.025) Copyright © 2011 Elsevier Inc. Terms and Conditions