Efficacy of the aldosterone antagonists in reducing the risk of postoperative atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis

Abstract Background Postoperative atrial fibrillation (PAOF) is a prevalent cardiac arrhythmia following heart surgeries, resulting in increased complications and prolonged hospital stays. Aldosterone antagonists (AA) demonstrate potential in managing PAF, but their effectiveness in significantly reducing the condition remains unclear in the existing literature. Purpose We conducted a meta-analysis to evaluate the efficacy of the AA in reducing the risk of PAOF in patients undergoing cardiac surgery. Methods PubMed, Embase, and Cochrane database were analyzed. Outcome analyzed was PAOF. A random effects model was used to calculate the risk ratios (RRs) with 95% confidence intervals. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I2 statistics. Results We included 756 patients from 3 studies. Of those, 2 were derived from RCTs. Spironolactone was administered to 338 patients out of the 409 patients who received AA. The remaining 71 patients received eplerenone as an intervention. The cardiac surgeries were: valvular surgery and coronary artery bypass graft (CABG). The use of AA was associated with a significant reduction in the risk of PAOF compared to non-use (RR 0.73; 95% CI 0.58-0.92; P = 0.007; I2 = 47%). Conclusion In this meta-analysis, AAs were associated with a lower risk of PAOF in patients undergoing cardiac surgery.