A hospital perspective on the cost-effectiveness ofβ-Blockade for prophylaxis of atrial fibrillation after cardiothoracic surgery

Gillespie, Effie L.; White, C Michael; Kluger, Jeffrey; Sahni, Jasmine; Gallagher, Rita Munley; Coleman, Craig I.

doi:10.1016/j.clinthera.2005.12.011

Cited by 17 publications

(11 citation statements)

References 12 publications

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“…The use of perioperative beta-adrenergic receptor blockers is well known to be useful to reduce myocardial ischemia [22][23][24][25][26][27][28][29], control tachycardia [18][19][20][21]30], and suppress arrhythmias [4][5][6][7][8][9]. Controlling these factors stabilizes hemodynamics and facilitates recovery, and may also be important when considering treatment costs [31]. In this retrospective review, landiolol was used to prevent myocardial ischemia (50% of group S), to control HR (21% of group S and 32% of group IM), and as an anti-arrhythmic drug (29% of group S and 68% of group IM) (Figs.…”

Section: Discussionmentioning

confidence: 99%

Clinical role and efficacy of landiolol in the intensive care unit

et al. 2008

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Beta-adrenergic receptor blockers have proved to be effective for the management of various cardiovascular diseases and the prevention of perioperative cardiac events and cerebrovascular accidents. Landiolol is a short-acting beta-blocker, with high beta 1-selectivity and a short duration of action. We thought landiolol was valuable and suitable for intensive care unit (ICU) patients, and conducted a retrospective study. The records of 80 patients (58 post-surgical patients; group S and 22 internal medicine patients; group IM) were reviewed. Thirty-seven (64%) of the group S patients were post-coronary artery bypass graft surgery, and the IM group consisted mostly of patients with acute myocardial infarction. The most common indication for landiolol in group S was the prevention of myocardial ischemia (50%), and in group IM, it was atrial fibrillation (45%). The median infusion rate of landiolol was 5 microg.kg(-1).min(-1) and the median infusion time was 2 days. Twenty-six patients were continued on oral beta-adrenergic receptor blockers. Landiolol reduced heart rate significantly without reducing blood pressure, and stabilized hemodynamics. We confirmed that landiolol is valuable as a bridge to starting oral beta-adrenergic receptor blockers and as an anti-arrhythmic agent, and that it is suitable for ICU patients due to its high beta 1-selectivity and rapid onset and offset of action.

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Section: Discussionmentioning

confidence: 99%

Clinical role and efficacy of landiolol in the intensive care unit

et al. 2008

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“…This hypothesis is based on two-step regime applied from a week before surgery, composed of (Zimmer et al, 2003) an oxidative stress stimulus to promote up-regulation of the endogenous enzymatic antioxidant defense system, through n −3 PUFA supplementation, followed by (Gillespie et al, 2005) a reinforcement of the non-enzymatic antioxidant component through supplements of vitamins C and E (Rodrigo et al, 2007b, 2008). Under these conditions, it should be expected a decreased vulnerability of cardiac tissue to the oxidative challenge occurring because of the ischemia–reperfusion event proper of this surgery.…”

Section: Hypothesis For a Novel Therapeutic Strategy Based On Modulatmentioning

confidence: 99%

“…It is associated with increased risk of stroke and death and constitutes a substantial use of healthcare resources, including increased duration of hospitalization and hospital costs (Zimmer et al, 2003; Gillespie et al, 2005, 2006). Together with flutter, it is one of the two most the common arrhythmias that develop in patients postoperatively following coronary artery bypass graft surgery with extracorporeal circulation.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Postoperative Atrial Fibrillation: Novel and Safe Strategy Based on the Modulation of the Antioxidant System

Rodrigo¹

2012

Front. Physio.

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Postoperative atrial fibrillation (AF) is the most common arrhythmia following cardiac surgery with extracorporeal circulation. The pathogenesis of postoperative AF is multifactorial. Oxidative stress, caused by the unavoidable ischemia–reperfusion event occurring in this setting, is a major contributory factor. Reactive oxygen species (ROS)-derived effects could result in lipid peroxidation, protein carbonylation, or DNA oxidation of cardiac tissue, thus leading to functional and structural myocardial remodeling. The vulnerability of myocardial tissue to the oxidative challenge is also dependent on the activity of the antioxidant system. High ROS levels, overwhelming this system, should result in deleterious cellular effects, such as the induction of necrosis, apoptosis, or autophagy. Nevertheless, tissue exposure to low to moderate ROS levels could trigger a survival response with a trend to reinforce the antioxidant defense system. Administration of n−3 polyunsaturated fatty acids (PUFA), known to involve a moderate ROS production, is consistent with a diminished vulnerability to the development of postoperative AF. Accordingly, supplementation of n−3 PUFA successfully reduced the incidence of postoperative AF after coronary bypass grafting. This response is due to an up-regulation of antioxidant enzymes, as shown in experimental models. In turn, non-enzymatic antioxidant reinforcement through vitamin C administration prior to cardiac surgery has also reduced the postoperative AF incidence. Therefore, it should be expected that a mixed therapy result in an improvement of the cardioprotective effect by modulating both components of the antioxidant system. We present novel available evidence supporting the hypothesis of an effective prevention of postoperative AF including a two-step therapeutic strategy: n−3 PUFA followed by vitamin C supplementation to patients scheduled for cardiac surgery with extracorporeal circulation. The present study should encourage the design of clinical trials aimed to test the efficacy of this strategy to offer new therapeutic opportunities to patients challenged by ischemia–reperfusion events not solely in heart, but also in other organs such as kidney or liver in transplantation surgeries.

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“…Furthermore, there was little difference in the overall rates of postoperative Af during the hospitalization period between the landiolol and control groups. 27) Intravenous administration of β -blockers may be more effective in reducing postoperative Af compared to oral administration, but intravenous drugs are also more expensive than oral drugs. 28) Therefore, at a certain time point it may be useful to shift from intravenous to oral administration of β -blockers for prevention of Af.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Landiolol Hydrochloride for Prevention of Atrial Fibrillation After Heart Valve Surgery

et al. 2012

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SummaryThe goal of this prospective study was to examine the effects of landiolol hydrochloride on prevention of atrial fibrillation and on hemodynamics in the acute postoperative phase after heart valve surgery. The subjects were 60 patients who underwent valve surgery at our hospital from April 2008 to July 2010. The patients were randomly divided into two groups: the landiolol group (30 patients) and the control (no landiolol) group (30 patients). In the landiolol group, continuous intravenous landiolol was initiated immediately on admission to the intensive care unit at a dose of 10 μg/kg/ minute. Occurrence of atrial fibrillation was compared between the groups over an observation period of 72 hours after surgery. Atrial fibrillation occurred in 6 patients (20%) in the landiolol group and 16 (53.3%) in the control group during the observation period. Landiolol hydrochloride significantly reduced the occurrence of atrial fibrillation in the acute postoperative phase after heart valve surgery. Heart rate was significantly decreased by landiolol, but aggravation of hemodynamics was not observed. These results suggest that landiolol is a useful drug for prevention of atrial fibrillation after valve surgery. (Int Heart J 2012; 53: 359-363) Key words: Heart valve disease, Ultra-short acting β -blocker A trial fibrillation or flutter (Af) is frequently observed during the perioperative period of cardiac surgery, with a reported incidence of 17% to 65%. 1,2) Postoperative Af may aggravate hemodynamics and cause embolic diseases, including cerebral infarction, and therefore prevention of this condition is an important issue in postoperative management. Various drugs have been developed for Af, including β -blockers that are useful for treatment of arrhythmia by decreasing heart strain through an antihypertensive effect. However, excessive inhibition of myocardial contraction and the strength of the antihypertensive effect are of concern in administration of a β -blocker after cardiac surgery.Landiolol hydrochloride (Ono Pharmaceutical Co., Ltd., Osaka, Japan) is highly selective for the β 1 receptor 3) and exerts a lower antihypertensive effect compared with its effect in decreasing heart rate. 4) Thus, landiolol has less impact on hemodynamics in the acute phase after cardiac surgery, compared to conventional β -blockers. Furthermore, since landiolol has a very short serum half-life of approximately 4 minutes, 4) it is easy to adjust the blood concentration without decreasing blood pressure or cardiac output. Recently, the utility of landiolol has been reported for prevention of Af after coronary artery bypass grafting (CABG).5-8) However, to our knowledge, the efficacy of landiolol for prevention of Af after heart valve surgery has not been examined. Therefore, in this study, we examined the effect of landiolol on Af and hemodynamics after heart valve surgery. Methods Patients and protocol:The study was performed in 60 patients who underwent valve replacement or valvuloplasty at our hospital from April 2008 to ...

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A hospital perspective on the cost-effectiveness ofβ-Blockade for prophylaxis of atrial fibrillation after cardiothoracic surgery

Cited by 17 publications

References 12 publications

Clinical role and efficacy of landiolol in the intensive care unit

Clinical role and efficacy of landiolol in the intensive care unit

Prevention of Postoperative Atrial Fibrillation: Novel and Safe Strategy Based on the Modulation of the Antioxidant System

Efficacy of Landiolol Hydrochloride for Prevention of Atrial Fibrillation After Heart Valve Surgery

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