Efficacy of Propafenone Hydrochloride in Preventing Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting
DOI:
https://doi.org/10.1532/HSF98.20091173Abstract
Background: Atrial fibrillation (AF) is one of the most common complications after coronary artery bypass grafting (CABG), and the incidence of postoperative AF (PAF) is estimated to range from 10% to 40%. PAF is a serious complication that is related to unstable hemodynamics, development of embolisms, patient discomfort, and increased medical costs associated with the prolongation of hospital stay. Sometimes, immediate attention is also necessary. In this study, we assessed the efficacy of treatment with the antiarrhythmic drug propafenone hydrochloride, which was administered in the early postoperative period, in preventing the development of PAF, and we attempted to identify risk factors for PAF.
Materials and Methods: The subjects were 78 patients who underwent isolated off-pump CABG between July 2007 and October 2008. We conducted the study by dividing the patients into 2 groups, a group of 26 patients who received propafenone hydrochloride (P group) and a control group of 52 patients who did not receive this drug (C group). The patients in the P group were given propafenone hydrochloride (150-450 mg/day orally) for 10 days, starting on the day after surgery, and were observed for the development of AF by means of continuous 12-lead electrocardiographic monitoring. Development of AF was defined as AF that lasted ?30 minutes or as supraventricular arrhythmia that required new treatment even though it did not persist for 30 minutes.
Results: The background factors of the patients in the P and C groups were similar. The operation times and the numbers of distal anastomoses in the 2 groups were similar, and there were no particular differences between the 2 groups with respect to postoperative factors. The incidence of PAF was 35% in the C group and significantly lower in the P group (12%, P = .0337). Moreover, multiple logistic regression analysis showed that propafenone hydrochloride was the sole factor that prevented the development of PAF (odds ratio, 0.207; 95% confidence interval, 0.053-0.804; P = .0229).
Conclusion: Cases must be carefully considered before administering propafenone hydrochloride, but the results of this study indicate that propafenone hydrochloride may prevent the development of PAF.
References
Almassi GH, Schowalter T, Nicolosi AC, et al. 1997. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg 226:501-11; discussion 511-3.nAndrews TC, Reimold SC, Berlin JA, Antman EM. 1991. Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials. Circulation 84(suppl):III236-44.nAranki 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.nCahill SA, Kirshenbaum LA, Gross GJ. 2001. Transient outward current inhibition by propafenone and 5-hydroxypropafenone in cultured neonatal rat ventricular myocytes. J Cardiovasc Pharmacol 38:460-7.nChidambaram M, Akhtar MJ, al-Nozha M, al-Saddique A. 1992. Relationship of atrial fibrillation to significant pericardial effusion in valve-replacement patients. Thorac Cardiovasc Surg 40:70-3.nCohn WE, Sirois CA, Johnson RG. 1999. Atrial fibrillation after minimally invasive coronary artery bypass grafting: a retrospective, matched study. J Thorac Cardiovasc Surg 117:298-301.nCoumel P. 1994. Autonomic arrhythmogenic factors in paroxysmal atrial fibrillation. In: Olsson SB, Allessie MA, Campbell RWF, eds. Atrial fibrillation: mechanisms and therapeutics strategies. Armonk, NY: Futura Publishing Co. p 171-85.nEagle KA, Guyton RA, Davidoff R, et al. 1999. ACC/AHA guidelines for coronary artery bypass graft surgery: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 100:1464-80.nEngelmann MD, Svendsen JH. 2005. Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J 26:2083-92.nHogue CW Jr, Hyder ML. 2000. Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment. Ann Thorac Surg 69:300-6.nJahangiri M, Weir G, Mandal K, Savelieva I, Camm J. 2006. Current strategies in the management of atrial fibrillation. Ann Thorac Surg 82:357-64.nJidéus L, Blomström P, Nilsson L, Stridsberg M, Hansell P, Blomström-Lundqvist C. 2000. Tachyarrhythmias and triggering factors for atrial fibrillation after coronary artery bypass operations. Ann Thorac Surg 69:1064-9.nKowey PR, Yannicelli D, Amsterdam E. 2004. Effectiveness of oral propafenone for the prevention of atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 94:663-5.nLeitch JW, Thomson D, Baird DK, Harris PJ. 1990. The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg 100:338-42.nLikosky DS, Caplan LR, Weintraub RM, et al., Northern New England Cardiovascular Disease Study Group, Lebanon, New Hampshire. 2004. Intraoperative and postoperative variables associated with strokes following cardiac surgery. Heart Surg Forum #1522-6662 7:E271-6.nMaisel WH, Rawn JD, Stevenson WG. 2001. Atrial fibrillation after cardiac surgery. Ann Intern Med 135:1061-73.nMarín F, Pascual DA, Roldán V, et al. 2006. Statins and postoperative risk of atrial fibrillation following coronary artery bypass grafting. Am J Cardiol 97:55-60.nMathew JP, Parks R, Savino JS, et al. 1996. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA 276:300-6.nMcLeod AA, Stiles GL, Shand DG. 1984. Demonstration of beta adrenoceptor blockade by propafenone hydrochloride: clinical pharmacologic, radioligand binding and adenylate cyclase activation studies. J Pharmacol Exp Ther 228:461-6.nMerrick AF, Odom NJ, Keenan DJ, Grotte GJ. 1995. Comparison of propafenone to atenolol for the prophylaxis of postcardiotomy supraventricular tachyarrhythmias: a prospective trial. Eur J Cardiothorac Surg 9:146-9.nOlshansky B. 1996. Management of atrial fibrillation after coronary artery bypass graft. Am J Cardiol 78:27-34.nRaja SG, Dreyfus GD. 2004. Incidence of atrial fibrillation after offpump and on-pump coronary artery surgery. Internet J Thorac Cardiovasc Surg 6(2).nSiebert J, Anisimowicz L, Lango R, et al. 2001. Atrial fibrillation after coronary artery bypass grafting: does the type of procedure influence the early postoperative incidence? Eur J Cardiothorac Surg 19:455-9.nZaman AG, Archbold RA, Helft G, Paul EA, Curzen NP, Mills PG. 2000. Atrial fibrillation after coronary artery bypass surgery: a model for preoperative risk stratification. Circulation 101:1403-8.nZebis LR, Christensen TD, Kristiansen IS, Hjortdal VE. 2008. Amiodarone cost effectiveness in preventing atrial fibrillation after coronary artery bypass graft surgery. Ann Thorac Surg 85:28-32.n
