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

  • Cevdet U?ur Koço?ullari
  • Mustafa Emmiler
  • Ercument Ayva
  • Taner Sasirtan
  • Naim Eren
  • Ahmet Cekirdekci

Abstract

Background. We investigated the effects of preoperative administration of beta-blockers on the incidence of atrial fibrillation (AF) after cardiothoracic surgery and the resulting morbidity and mortality.

Methods. We retrospectively evaluated 181 patients who underwent operations between May 2004 and December 2007. We divided the patients into 2 groups according to their preoperative use beta-blockers. Group A (n = 89) consisted of patients who did not receive beta-blockers, and group B (n = 92) consisted of patients who received 50 mg metoprolol succinate daily. All patients underwent on-pump coronary artery bypass grafting (CABG) via sternotomy.

Results. Atrial sizes and the baseline clinical and laboratory data were similar for the 2 groups. The 2 groups were also similar with respect to the numbers of grafts per patient, preoperative ejection fractions, cross-clamp times, cardiopulmonary bypass times, and postoperative inotrope use (P > .05). AF occurred in 39 (21.5%) of the 181 patients after the operation. Postoperative AF occurred in 30 (33.7%) of the group A patients and in 9 patients (9.7%) in group B (P < .05).

Conclusion. Postoperative AF increases the rates of morbidity and mortality and the length of hospital stay after CABG. The prophylactic use of beta-blockers decreases the rate of postoperative AF and thus AF-related complications.

References

Aranki SF, Shaw DP, Adams DH, et al. 1996. Predictors of atrial fibrillation after coronary artery surgery: current trends and impact on hospital resources. Circulation 94:390-7.\nBaker WL, White CM. 2007. Post-cardiothoracic surgery atrial fibrillation: a review of preventive strategies. Ann Pharmacother 41:587-98.\nBoos CJ, Anderson RA, Lip GY. 2006. Is atrial fibrillation an inflammatory disorder? Eur Heart J 27:136-49.\nBradley D, Creswell LL, Hogue CW Jr, Epstein AE, Prystowsky EN, Daoud EG,. American College of Chest Physicians. 2005. Pharmacologic prophylaxis: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 128(suppl 2):39S-47S.\nBruins P, te Velthuis H, Yazdanbakhsh AP, et al. 1997. Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation 96:3542-8.\nCrozier I, Melton I, Pearson S. 2003. Management of atrial fibrillation in the emergency department. Intern Med J 33:82-5.\nEslami M, Badkoubeh RS, Mousavi M, et al. 2007. Oral ascorbic acid in combination with beta-blockers is more effective than beta-blockers alone in the prevention of atrial fibrillation after coronary artery bypass grafting. Tex Heart Inst J 34:268-74.\nEvrard P, Gonzalez M, Jamart J, et al. 2000. Prophylaxis of supraventricular and ventricular arrhythmias after coronary artery bypass grafting with low-dose sotalol. Ann Thorac Surg 70:151-6.\nFontes ML, Mathew JP, Rinder HM, et al. 2005. Atrial fibrillation after cardiac surgery/cardiopulmonary bypass is associated with monocyte activation. Anesth Analg 101:17-23.\nFuster V, Rydén LE, Cannom DS, et al. 2006. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace 8:651-745; erratum, Europace 9:856.\nImren Y, Benson AA, Zor H, et al. 2007. Preoperative beta-blocker use reduces atrial fibrillation in off-pump coronary bypass surgery. ANZ J Surg 77:429-32.\nKerstein J, Soodan A, Qamar M, et al. 2004. Giving IV and oral amiodarone perioperatively for the prevention of postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery: the GAP study. Chest 126:716-24.\nKorantzopoulos P, Kolettis TM, Galaris D, Goudevenos JA. 2007. The role of oxidative stress in the pathogenesis and perpetuation of atrial fibrillation. Int J Cardiol 115:135-43.\nLikosky DS, Caplan LR, Weintraub RM, et al. 2004. Intraoperative and postoperative variables associated with strokes following cardiac surgery. Northern New England Cardiovascular Disease Study group, Lebanon, New Hampshire. Heart Surg Forum 7:E271-6.\nMartinez EA, Bass EB, Zimetbaum P,. American College of Chest Physicians. 2005. Pharmacologic control of rhythm: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 128(suppl 2):48S-55S.\nMartinussen HS, Lolk A, Szezepanski C, Alstrup P. 1988. Supraventricular tachyarrhythmias after coronary bypass surgery: a double blind randomized trial of prophylactic low dose propranolol. Thorac Cardiovasc Surg 36:206-7.\nMcKeown PP,. American College of Chest Physicians. 2005. Introduction: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 128(suppl 2):6S-8S.\nRoach GW, Kanchuger M, Mangano CM, et al. 1996. Adverse cerebral outcomes after coronary bypass surgery. N Engl J Med 335:1857-63.\nSaltman AE. 2003. Is it time to choose amiodarone for postoperative atrial fibrillation? J Thorac Cardiovasc Surg 125:1202-3.\nEagle KA, Guyton RA, Davidoff R, et al.,. for the American College of Cardiology and the American Heart Association. 2004. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 110:e340-437.\nEngelmann MDM, Svendsen JH. 2005. Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J 26:2083-92.\n
Published
2008-06-26
How to Cite
Koço?ullari, C., Emmiler, M., Ayva, E., Sasirtan, T., Eren, N., & Cekirdekci, A. (2008). Preoperative Prophylaxis Can Decrease Rates of Atrial Fibrillation in Open Heart Surgery: A Retrospective Study. The Heart Surgery Forum, 11(3), E159-E163. https://doi.org/10.1532/HSF98.20081003
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Articles

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