Background and Goal of study: The incidence of atrial fibrillation (Af) is associated with in-hospital mortality after cardiovascular surgery [1]. Several studies reported that a low-dose landiolol might prevention postoperative Af in patients who received cardiovascular surgery [2,3]. We conducted a systematic review to reveal whether a low-dose landiolol administration could prevent the incidence of Af for post-cardiovascular surgery patients compared with placebo.
Material and Methods: To identify randomized controlled studies investigating the prevention of landiolol on the incidence of Af for post-cardiovascular surgery patients, a search was conducted in PubMed, Cochrane, and ICHUSHI Web (the largest database for Japanese medical journals) on 8 November 2016 using the following search terms: (((random) OR randomized)) AND ((short acting beta blocker) OR landiolol). Two independent reviewers screened the abstracts and titles of the studies and subsequently reviewed the full-text articles for inclusion. The primary outcome is the incidence of Af after surgery, the secondary outcome is the hospital mortality and complications such as severe bradycardia. All statistical analyses were carried out with　Review Manager Version 5.3.. The level of statistical significance was set at a P value of < 0.05.
Results and Discussion: Of the 430 articles identified in the primary search, the title and abstract review excluded 404 articles. Of the 26 remaining articles, only 6 articles were remained after the full-text review. We conducted the systematic review of 6 manuscripts (571 patients), all researches performed in Japan.  The incidence of Af within a week after surgery is significantly lower in the landiolol group compared to the control group（Odds Ratio (OR) 0.27 [95% confidence interval (CI):0.18-0.42] (p<0.00001)）. Three of 6 manuscripts included the hospital mortality and complications, there was no deference in secondary outcome between two groups（hospital mortality：OR 0.45 [95% CI:0.07-2.74] (p=0.39)、complications：OR 0.45 [95% CI:0.16-1.23] (p=0.12). Our meta-analysis suggested that a low-dose landiolol might be an optimal agent for prevention of postoperative Af in terms of balance of the benefit and the risk.
Conclusion: A low-dose landiolol administration can prevent the incidence of Af for post-cardiovascular surgery patients. Further large trials are needed to confirm or refute these findings.

Prevention of atrial fibrillation with low-dose landiolol in post-cardiovascular surgery patients: a systematic review and meta-analysis