Levosimendan Use Decreases Atrial Fibrillation in Patients after Coronary Artery Bypass Grafting: A Pilot Study
AbstractBackground: Atrial fibrillation (AF) often occurs after coronary artery bypass grafting (CABG) and can result in increased morbidity and mortality due to complications. In the present study, our goal was to investigate whether the use of levosimendan can reduce the frequency of AF after coronary artery bypass grafting in patients with poor left ventricle function.
Material and Methods: To investigate the effectiveness of levosimendan in the prophylaxis of AF, we conducted a prospective, randomized, placebo-controlled clinical study on 200 consecutive patients in whom we performed elective CABG operations. Baseline characteristics were similar in both groups. A control group of 100 patients were treated with placebo (500 mL saline solution), whereas the levosimendan group (n = 100 patients) was treated with levosimendan. High-sensitivity C-reactive protein, cardiac troponin, and creatine kinase–MB levels were measured before surgery and 5 days postoperatively.
Results: AF occurred in 12% of the levosimendan group and 36% of the control group. The occurrence of AF was significantly lower in the levosimendan group (P < 0.05). The duration of AF in the levosimendan group was significantly shorter than that in the control group (4.83 Â± 1.12 and 6.50 Â± 1.55 hours, respectively; P = 0.028). Our research showed that C-reactive protein was higher postoperatively in the control group than in the levosimendan group (P < 0.05).
Conclusions: The incidence of postoperative AF in the levosimendan group was reduced significantly in patients with poor left ventricle function after CABG operations.
Aerra V, Kuduvalli M, Moloto AN, et al. 2006. Does prophylactic sotalol and magnesium decrease the incidence of atrial fibrillation following coronary artery bypass surgery: a propensity-matched analysis. J Cardiothoracic Surgery 3:6.nAllesie MA, Boyden PA, Camm AJ, et al. 2001. Pathophysiology and prevention of atrial fibrillation. Circulation 103:769-77.nAlmassi GH, Schowalter T, Nicolosi AC, et al. 1997. Atrial fibrillation after cardiac surgery. A major morbid event? Ann Surg 226:501-11.nAranki SF, Shaw DP, Adams DH, et al. 1996. Predictors of atrial fibrillation after coronary artery surgery. Circulation 94:390-7.nAviles RJ, Martin DO, Apperson-Henson C, et al. 2003. Inflammation as a risk factor for atrial fibrillation. Circulation 108:3006-10.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 36:3542-8.nBudeus M, Hennersdorf M, Perings S, et al. 2006, Amiodarone prophylaxis for atrial fibrillation of high risk patients after coronary artery bypass grafting: a prospective, double-blinded, placebo-controlled, randomized study. Eur Heart J 27:1584-91.nCreswell LL, Schuessler RB, Rosenbloom M, Cox JL. 1993. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 56:539-549.nDaoud EG, Strickberger SA, Man KC, et al. 1997. Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Engl J Med 337:1785-91.nFiggitt DP, Gillies PS, Goa KL. 2001. Levosimendan. Drugs 61:613-27.nFrishman WH. 2003. Advances in positive inotropic therapy: levosimendan. Crit Care Med 31:2408-9.nGomes JA, Ip J, Santoni-Rugiu F, Mehta D, et al. 1999. Oral d, I sotalol reduces the incidence of postoperative atrial fibrillation in coronary artery bypass surgery patients: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 34:334-9.nHakala T, Pitkanen O, Hippelainen M. 2002. Feasibility of predicting the risk of atrial fibrillation after coronary artery bypass surgery with logistic regression model. Scand J Surg 91:339-44.nLeal JC, Petrucci O, Godoy MF, Braile DM. 2012. Perioperative serum troponin I levels are associated with higher risk for atrial fibrillation in patients undergoing coronary artery bypass graft surgery. Interact Cardiovasc Thorac Surg 14:22-5.nLeather HA, Ver Eycken K, Segers P, Herijgers P, Vandermeersch E, Wouters PF. 2003. Effects of levosimendan on right ventricular function and ventriculovascular coupling in open chest pigs. Crit Care Med 31:2339-43nLehtonen L. Levosimendan. 2001. a parenteral calcium-sensitising drug with additional vasodilatory properties. Expert Opin Investig Drugs 10:955-70.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.nMahoney EM, Thompson TD, Veledar E, Williams J, Weintraub WC. 2002. Cost-effectiveness of targeting patients undergoing cardiac surgery for therapy with intravenous amiodarone to prevent atrial fibrillation. J Am Coll Cardiol 40:737-45.nMassoudy P, Zahler S, Barankay A, Becker BF, Richter JA, Meisner H. 1999. Sodium nitroprusside during coronary artery bypass grafting: evidence for an antiinflammatory action. Ann Thorac Surg 67:1059-64.nMcBride BF, White CM. 2003. Levosimendan: implications for clinicians. J Clin Pharmacol 43:1071-81.nNieminen MS, Akkila J, Hasenfuss G, et al. 2000. Hemodynamic and neurohumoral effects of continuous infusion of levosimendan in patients with congestive heart failure. J Am Coll Cardiol 36:1903-12.nPatti G, Chello M, Candura D, et al. 2006. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of Myocardial Dysrhythmia After cardiac surgery) study. Circulation 114:1455-61.nPrasongsukarn K, Abel JG, Jameison E, et al. 2005. The effects of steroids on occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: a prospective randomized trial. J Thorac Cardiovasc Surg 130:93-8.nRedle JD, Khurana S, Marzan R, et al. 1999. Prophylactic oral amiodarone compared with placebo for prevention of atrial fibrillation after coronary artery bypass surgery. Am Heart J 138:144-50.nRoldan V, Marin F, Diaz J, et al. 2012. High sensitivity cardiac troponin t and interleukin-6 predict adverse cardiovascular events and mortality in anticoagulated patients with atrial fibrillation. J Thromb Haemostasis 10:1500-7.nSlawsky MT, Colucci WS, Gottlieb SS, et al. 2000. Acute hemodynamic and clinical effects of levosimendan in patients with severe heart failure. Study Investigators. Circulation 102:2222-7.nSolomon A, Berger A, Triverdi K, Hannan R, Katz N. 2000. The combination of propranolol and magnesium does not prevent postoperative atrial fibrillation. Ann Thorac Surg 69:126-9.nSorsa T, Heikkinen S, Abbott MB, et al. 2001. Binding of levosimendan, a calcium sensitizer, to cardiac troponin C. J Biol Chem 276:9337-43.nSvedjeholm R, Hakanson E. 2000. Predictors of atrial fibrillation in patients undergoing surgery for ischemic heart disease. Scand Cardiovasc J 34:516-21.nTokmakoglu H, Kandemir O, Gunaydin S, Catav Z, Yorgancioglu C, Zorlutuna Y. 2002. Amiodarone versus digoxin and metoprolol combination for prevention of postcoronary bypass atrial fibrillation. Eur J Cardiothorac Surg 21:401-5.nTreggiari-Venzi MM, Waeber JL, Perneger TV, Suter PM, Adamec R, Romand JA. 2000. Intravenous amiodarone or magnesium sulphate is not cost-beneficial prophylaxis for atrial fibrillation after coronary artery bypass surgery. Br J Anaesth 85:690-5.n
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