Effectiveness of Anti-Inflammatory Agents to Prevent Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Network Meta-Analysis

Background: Preventing postoperative atrial fibrillation (POAF) as one of the most significant complications of cardiovascular surgeries remains a major clinical challenge. We conducted a systematic review with network meta-analysis of randomized controlled trials, to identify the most effective and safe anti-inflammatory drugs to prevent new-onset POAF. Methods: MEDLINE, Embase, Web of Science, and Cochrane Library were searched without language or publication-date restriction on August 8, 2022 (updated on August 8, 2023). We assessed the risk of bias of included trials using the Cochrane risk-of-bias 2.0 tool. We conducted a frequentist random-effects network meta-analysis in R, and we assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Results: A total of 85 trials reported the incidence of new-onset POAF, including 18,981 patients. Use of nonsteroidal anti-inflammatory drugs (relative risk RR 0.37 95% confidence interval [CI 0.23-0.59]) and statins (RR 0.56 95% CI 0.45-0.7) potentially reduced the risk of POAF compared with placebo (both with a moderate certainty level). Use of fish oil in combination with vitamins C and E (RR 0.30 95% CI 0.13-0.68) may reduce the risk of POAF, compared with placebo (low level of certainty). Use of colchicine (RR 0.62 95% CI 0.45- 0.85), corticosteroids (RR 0.70 95% CI 0.59-0.82), and N-acetylcysteine (RR 0.69 95% CI 0.49- 0.98) may reduce the risk of POAF (all with a low level of certainty). None of the interventions had a significant effect on mortality rate or risk of serious adverse effects. Conclusions: Use of nonsteroidal anti-inflammatory drugs and statins probably are effective in preventing new-onset POAF, with a moderate level of certainty, compared to placebo.