Prevention of atrial fibrillation onset by beta-blocker treatment in heart failure: a meta-analysis

• Published in: European heart journal 2007-02, Vol.28 (4), p.457-462
• Main Authors: Nasr, Imad Abi, Bouzamondo, Anissa, Hulot, Jean-Sébastien, Dubourg, Olivier, Le Heuzey, Jean-Yves, Lechat, Philippe
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Atrial Fibrillation - etiology; Atrial Fibrillation - prevention & control; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Chronic Disease; Double-Blind Method; Heart; Heart Failure - complications; Heart Failure - drug therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Medical sciences; Middle Aged; Randomized Controlled Trials as Topic
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehl484

Aims Atrial fibrillation (AF) is an important morbidity-mortality risk factor, especially in patients with heart failure (HF). Beta-blockers reduce morbidity and mortality in HF. The study was designed to estimate the preventive efficacy of beta-blocker treatment on AF occurrence in patients with HF. Methods and results A systematic review of the literature was performed to identify all clinical trials evaluating beta-blockers' efficacy in HF. Eligible studies had to be randomized, placebo-controlled and providing information on the incidence of AF during follow-up among those with sinus rhythm at baseline. A total of seven studies which included 11 952 patients receiving a background treatment with angiotensin-converting enzyme-inhibitors could be found. Overall, beta-blockers significantly reduced incidence of onset of AF from 39 to 28 per 1000 patient-years: relative risk reduction = 27% (95% confidence interval 14-38, P < 0.001); heterogeneity test: P = 0.096. A same trend of efficacy was observed in all trials except the SENIORS study. In this trial which included aged patients (>70 years) with systolic or diastolic HF, a higher prevalence of AF at baseline (35%) was observed compared with the mean baseline prevalence (13%). Conclusion Beta-blockers appear to effectively prevent occurrence of AF in patients with systolic HF.