The impact of beta-blocker use on postoperative atrial fibrillation after aortic valve replacement

Abstract

Background: Current guidelines recommend perioperative use of beta-blocker (BB) in patients undergoing cardiac surgery to prevent postoperative atrial fibrillation (POAF). However, this recommendation is mainly based on studies those exclusively enrolled patients undergoing coronary artery bypass grafting. This study was conducted to evaluate the impact of perioperative BB use on the occurrence of POAF after aortic valve replacement (AVR). Methods: From January 2015 to June 2018, 296 patients (male: female = 163:133) who underwent AVR at our institution were retrospectively reviewed. Patients who underwent concomitant valve surgery other than AVR or patients with preoperative arrhythmia were excluded. Mean age at the operation was 67±12 years. All patients were continuously tele-monitored for the occurrence of AF until discharge. Occurrence of any short runs of AF during the hospital stay was treated as POAF. Early outcomes were evaluated and perioperative factors associated with POAF were analyzed using a multivariable logistic regression model. Results: Early mortality rate was 3.7% (11 of 296 patients). The POAF occurred in 154 patients (52.0%).Univariate analyses demonstrated that postoperative use of BB as well as age, type of prosthesis, history of stroke, body surface area, and chronic kidney disease were associated with the occurrence of POAF. The multivariable model showed that postoperative use of BB within 24 hours after AVR was a preventive factor of POAF (odds ratio, 0.354; 95% CI, 0.163 to 0.770; P=0.009). Conclusions: Postoperative use of BB within 24 hours after AVR rather than preoperative use might be effective in prevention of POAF.

Short-term and Long-term Risk of Stroke in Patients With Perioperative Atrial Fibrillation After Cardiac Surgery: Systematic Review and Meta-analysis

“…Three primary study authors provided unpublished information on the number of short-term and long-term strokes. 46,48,60 Unpublished outcome data with multivariable adjustment were provided by primary study authors for four studies. 3,12,30,46 9/32…”

“…46,48,60 Unpublished outcome data with multivariable adjustment were provided by primary study authors for four studies. 3,12,30,46 9/32…”

Prophylactic Left Atrial Appendage Ligation During Coronary Artery Bypass Graft Surgery Allows Safe Avoidance of Anticoagulation Regardless of Postoperative Atrial Fibrillation

“…Due to structural age-related changes, coronary artery disease may be more advanced in older patients, further increasing the risk of POAF. Postoperatively, betablockers have been consistently shown to be useful prophylactic and treatment options for POAF, reducing morbidity and mortality [36]. Other antiarrhythmic drugs, such as amiodarone, have also been used to curb morbidity in POAF patients [37].…”

Evaluation of Perioperative Beta-Blockers and Factors Associated with Postoperative Atrial Fibrillation in Cardiac Surgery: A Single Center Experience

“…A study by Kim et al . [ 29 ] observed administering beta-blockers prior to aortic valve replacement surgery (on the occurrence of AF), did not yield protective effects. However, when beta-blocker therapy was initiated immediately after surgery, a protective effect was observed.…”