Prevention of perioperative atrial fibrillation with betablockers in coronary surgery: betaxolol versus metoprolol

Abstract

In this study, we tried to compare the efficacy and safety of betaxolol vs. metoprolol immediately postoperatively in coronary artery bypass grafting (CABG) patients and to determine whether prophylaxy for atrial fibrillation (AF) with betaxolol could reduce hospitalization and economic costs after cardiac surgery. Our trial was open-label, randomized, multicentric enrolling 1352 coronary surgery patients randomized to receive betaxolol or metoprolol. The primary endpoints were the composites of 30-day mortality, in-hospital AF (safety endpoints), duration of hospitalization and immobilization, quality of life, and the above endpoint plus in-hospital embolic event, bradycardia, gastrointestinal symptoms, sleep disturbances, cold extremities (efficacy plus safety endpoint). At the end of the study the incidence and probability of early postoperative AF with betaxolol was lower than with metoprolol in coronary surgery (P<0.0001). In the two study groups minor side effects were similar and no major complication was reported (P<0.001). Patient compliance was good and the general condition improved due to shortened hospitalization and immobilization with subsequent improvement in the psychological status, less arrhythmias and lack of significant side effects. In conclusion, because of its efficacy and safety, betaxolol was superior to metoprolol for the prevention of the early postoperative AF in coronary surgery.

Postoperative Atrial Fibrillation

“…Systemic sympathetic tone can be increased as well, due to a systemic inflammatory response to surgical trauma and pain, and circulating catecholamines may act on the sensitized atrial myocardium shortening refractory period, causing atrial reentry or promoting triggered automaticity to produce arrhythmias [32]. Thus, perioperative beta-blockade exerts similar effects and can play a role in limiting postoperative atrial arrhythmias [34]. …”

Predicting New-Onset Postoperative Atrial Fibrillation in Cardiac Surgery Patients

“…9 Many interventions have been proposed to prevent POAF, often resulting in decreased hospital cost and length of stay. [10][11][12] Most preventive measures involve medications to control heart rate or rhythm:beta-blockers, [13][14][15] amiodarone, 16-19 diltiazem, 20, 21 digoxin, 22 propafenone, 23, 24 and sotalol. 25,26 Other therapies target anti-inflammatory mechanisms: HMG-CoA reductase inhibitors, 27-29 corticosteroids, 30 angiotensin-converting enzyme inhibitors, 31 angiotensin receptor blockers, 32 N -3 fatty acids 33-35 and naproxen.…”

Peripheral vasoconstriction induced by β‐adrenoceptor blockers: a systematic review and a network meta‐analysis

“…The main reasons for excluding records were that studies were in vitro studies, or were not randomized clinical trials, or were RCTs that did not report the incidence of peripheral vasoconstriction. Thirty‐eight studies finally fulfilled the eligibility criteria . (Figure ).…”