Supraventricular Tachyarrhythmias After Coronary Bypass Surgery - A Double Blind Randomized Trial of Prophylactic Low Dose Propranolol

Hj, Martinussen; Lolk, Annette; Szczepański, Cezary; Alstrup, P

doi:10.1055/s-2007-1020079

Cited by 39 publications

(10 citation statements)

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“…Most of the trials excluded patients with severely decreased left ventricular function, and the reported values of mean ejection fraction of the patients enrolled were in the range of 43% to 68%. 19,46 The percentage of patients with history of previous myocardial infarction varied from 26% to 85%. 25,47 The prevalence of use of preoperative ␤-blockers varied, because some trials were designed to evaluate the role of ␤-blocker withdrawal phenomena, 23 whereas others excluded patients not taking ␤-blockers preoperatively.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

“…11,24,25 In trials published after 1995, the proportion of patients undergoing ␤-blocker therapy preoperatively was 61% to 80%. 12,13,33 The timing of initiation of study treatment varied between the trials, starting before, 9,10,18,19,25,38,39,41,43,45,48,49 during, 44 or after 6,11-17,20 -24,26 surgery. In 2 trials, 16,31 the intervention drug was administered at the end of ICU stay.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

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Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery

et al. 2002

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Background-Postoperative atrial fibrillation (AF) is a common complication of cardiac surgery and has been associated with increased incidence of other complications and increased hospital length of stay (LOS). Prevention of AF is a reasonable clinical goal, and, consequently, many randomized trials have evaluated the effectiveness of pharmacological and nonpharmacological interventions for prevention of AF. To better understand the role of various prophylactic therapies against postoperative AF, a systematic review of evidence from randomized trials was performed. Methods and Results-Fifty-two randomized trials (controlled by placebo or routine treatment) of ␤-blockers, sotalol, amiodarone, or pacing were identified by systematic literature search.

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Section: Pharmacological Interventionsmentioning

confidence: 99%

Section: Pharmacological Interventionsmentioning

confidence: 99%

Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery

et al. 2002

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“…The efficacy of pharmacologic prophylaxis in reducing the incidence of AF has been investigated in several studies, and different studies have addressed the issue of preventing AF after CABG [Martinussen 1988;Kerstein 2004;Bradley 2005;Imren 2007].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Prophylaxis Can Decrease Rates of Atrial Fibrillation in Open Heart Surgery: A Retrospective Study

Koçoğulları¹,

Emmıler²,

Ayva³

et al. 2008

The Heart Surgery Forum

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“…Morcover, some of the beta-blocker trials showed conflicting results (8,9,30). In one study with a high douse of sotalol, there was a marked reduction in supraventricular tachyarrhythmias (22).The present report confirms the results of Suttorp ct al (23) and extends it to an unselected group of patients showing that a low dose of sotalol is sufficient to prevent supraventricular tachyarrhythmias in a large proportion of patients.…”

Section: Incidence and Predictors Of Supraventricular Tachyarrhythmiasmentioning

confidence: 98%

“…It has been suggested that this complication could be reduced by modern cardioprotection during general anesthesia (3,4). Several antiarrhythmic drugs have been used to treat or prevent these supraventricular arrhythmias such as digoxine (6,7), beta-adrenergic blocking drugs (8)(9)(10), calcium antagonists (11), quinidine (12), propafenone (13), flecainide (14), procainamide (15), amiodarone (16,17), and magnesium (18). Whereas there are conflicting results from different studies for most of these drugs, this is not true for beta-blocking drugs.…”

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confidence: 99%

Significance of Supraventricular Tachyarrhythmias After Coronary Artery Bypass Graft Surgery and Their Prevention by Low-Dose Sotalol: A Prospective Double-Blind Randomized Placebo-Controlled Study

Weber¹,

Oßwald²,

Buser³

et al. 1998

J Cardiovasc Pharmacol Ther

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BACKGROUND: The single most frequent complication after coronary artery bypass graft surgery is the occurrence of supraventricular tachyarrhythmias leading to a prolonged hospital stay. Although several drugs have been used to treat these arrhythmias, effective prevention was only possible with beta-blocking drugs in selected patients. It was, therefore, the aim of the present study to evaluate the significance of supraventricular tachyarrhythmias in presence of today's cardioprotective management in a broad spectrum of patients and to assess the possible preventive effect and safety of low-dose sotalol after coronary artery bypass graft surgery. METHODS AND RESULTS: In a prospective randomized double-blind placebo-controlled trial, 220 consecutive patients referred for elective coronary artery bypass graft surgery were randomized to 80 mg sotalol twice daily (n = 110) or matching placebo (n = 110) for 3 months with the first dose given 2 hours before surgery. There were no significant differences in baseline characteristics between the two groups. Low-dose sotalol reduced the rate of supraventricular arrhythmias from 43% (placebo) to 25% (sotalol, P <.01), which was atrial fibrillation in 83%, flutter in 7%, and other supraventricular arrhythmias in 10%. Only 7% of all arrhythmias were observed after day 9. Hospital stay was 11 +/- 4 days in patients with supraventricular arrhythmias versus 9 +/- 2 days (P <.001) in patients without. On the fourth postoperative day, heart rate was lower in the sotalol group (75 +/- 12 versus 86 +/- 14 beats per min; P <.0001), but QTc was not significantly prolonged (sotalol, 0.44 +/- 0.03; placebo, 0.43 +/- 0.03; P, ns). Study medication had to be discontinued due to side effects in 6.4% of sotalol and 3.6% of placebo patients (P, ns), but relevant side effects occurred only in two sotalol patients late after surgery. CONCLUSIONS: These data show that without antiarrhythmic therapy the incidence of supraventricular arrhythmias after coronary artery bypass graft surgery is high (43%) and that supraventricular arrhythmias were associated with a prolonged hospital stay (+/-2 days). Prophylactic treatment with low-dose sotalol reduced the incidence of supraventricular arrhythmias significantly (by 40%), thereby reducing overall hospital stay in treated patients. Because more than 90% of all supraventricular arrhythmic episodes occurred within 10 days after surgery and considering the small proarrhythmic effect of sotalol late after surgery, prophylactic treatment with sotalol may be recommended for the first 10 postoperative days to safely reduce supraventricular tachyarrhythmias.

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Supraventricular Tachyarrhythmias After Coronary Bypass Surgery - A Double Blind Randomized Trial of Prophylactic Low Dose Propranolol

Cited by 39 publications

References 0 publications

Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery

Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery

Preoperative Prophylaxis Can Decrease Rates of Atrial Fibrillation in Open Heart Surgery: A Retrospective Study

Significance of Supraventricular Tachyarrhythmias After Coronary Artery Bypass Graft Surgery and Their Prevention by Low-Dose Sotalol: A Prospective Double-Blind Randomized Placebo-Controlled Study

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