Perioperative amiodarone significantly reduced the incidence of postoperative atrial fibrillation by 61% (OR 0.39) compared to placebo or no treatment in patients undergoing cardiac surgery.
Meta-Analysis (n=6,166)
Does perioperative amiodarone prevent postoperative atrial fibrillation in patients undergoing cardiac surgery?
Perioperative amiodarone significantly reduces the incidence of postoperative atrial fibrillation and length of hospital stay in cardiac surgery patients, though it increases the risk of bradycardia.
Effect estimate: OR 0.39 (95% CI 0.31-0.49)
p-value: p=<0.00001
Abstract Background Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery, and perioperative amiodarone is recommended for POAF prophylaxis, while the optimal timing, route, and dosage remain unclear. The purpose of this study is to evaluate the efficacy of perioperative amiodarone for the prevention of POAF in patients undergoing cardiac surgery and to reevaluate the impact of its timing, route, and dosage. Methods Data were collected through searching PubMed, Embase, and the Cochrane Library from inception until September 30, 2025, for randomized controlled trials (RCTs). Data were pooled using a random-effects model. Results Forty RCTs involving 6,166 patients were included. Amiodarone was associated with a substantial reduction in the incidence of POAF (odds ratio OR 0.39, 95% confidence interval CI 0.31 to 0.49, P < 0.00001, I 2 = 57%). The preventive efficacy may be primarily influenced by the combination of administration timing and route, rather than by the cumulative dose alone. Notably, a significant dose–response relationship was observed within the preoperative through postoperative oral strategy. Statistically significant differences were found in length of hospital stay (mean difference -1.33 days, P < 0.0001) and cerebrovascular accident (OR = 0.59, P = 0.04), and an increased risk of bradycardia (OR = 2.33, P < 0.00001). No statistically significant differences were found in mortality, heart block, or hypotension. Conclusions Prophylactic perioperative amiodarone may be associated with a reduced incidence of POAF, consistent with current guideline recommendations, and the timing and route of administration appear to play a more important role than the dose alone. While an increased risk of bradycardia was observed, no clear association with major adverse outcomes was identified. These results should be interpreted cautiously and may help optimize prophylactic strategies in appropriate clinical contexts.
Li et al. (Thu,) conducted a meta-analysis in Postoperative atrial fibrillation (POAF) in cardiac surgery (n=6,166). Amiodarone vs. Placebo or no treatment was evaluated on Incidence of postoperative atrial fibrillation (POAF) (OR 0.39, 95% CI 0.31-0.49, p=<0.00001). Perioperative amiodarone significantly reduced the incidence of postoperative atrial fibrillation by 61% (OR 0.39) compared to placebo or no treatment in patients undergoing cardiac surgery.