Introduction: As current evidence regarding the protective role of coenzyme Q10 on atrial fibrillation is inconclusive, we undertook a meta-analysis to investigate the impact of coenzyme Q10 on the prevention of postoperative atrial fibrillation following cardiac surgery. Methods: A comprehensive search of the PubMed, Web of Science, Embase, and Cochrane Library databases was conducted to identify relevant randomized controlled trials. The search encompassed the period from the inception of the databases to April 1st, 2024, without language restrictions. Meta-analysis was carried out with Review Manager 5.3. The risk ratio (RR) was employed to assess the effect. Results: Five randomized controlled trials with 216 patients were finally included. It was shown that perioperative use of coenzyme Q10 significantly reduced the incidence of postoperative atrial fibrillation compared with the control group (RR: 0.55; 95% CI: 0.33-0.90; P=0.02; I ²=0%). Conclusion: Coenzyme Q10 might be a prophylactic treatment for postoperative atrial fibrillation following cardiac surgery.