Postoperative atrial fibrillation (POAF) is a common complication, occurring in up to 30% of patients undergoing cardiac surgery. Landiolol, an ultrashort-acting and highly β1-selective intravenous beta blocker, has been evaluated for POAF prevention. A meta-analysis of randomized clinical trials (RCTs), published in Anaesthesia Critical Care and Pain Medicine, assessed its efficacy and safety in this setting.

Electronic databases were systematically searched to identify RCTs evaluating landiolol for POAF prevention after cardiac surgery. A total of 11 RCTs involving 1,264 patients were included.

Dichotomous outcomes were reported as odds ratios (ORs), and continuous outcomes as mean differences (MDs), each with 95% confidence intervals (CIs). The primary endpoint was the incidence of POAF.

Landiolol was related to a significantly lower incidence of POAF compared with the control group (OR 0.35; 95% CI 0.23-0.53; P<0.01). No significant differences were observed between groups in hospital mortality, length of hospital stay, heart failure, or major complications.

These findings support the use of landiolol for reducing POAF incidence after cardiac surgery; however, larger multi-ethnic RCTs are needed to confirm these results and generalizability.