Original article: cardiovascularPreoperative use of sotalol versus atenolol for atrial fibrillation after cardiac surgery
Section snippets
Patients and method of randomization
From January 1999 to February 2002, 253 consecutive patients scheduled to undergo cardiac surgery were enrolled prospectively in this study.
Ventricular function was evaluated in all patients in the 2 months preceding the intervention, by using either echocardiography or left ventricular angiography. Exclusion criteria consisted of the following: (1) a left ventricular ejection fraction (LVEF) less than 35% or a clinical diagnosis of congestive heart failure; (2) any degree of atrioventricular
Characteristics of patients and incidence of AF
The clinical data, hemodynamics, preoperative echocardiographs, and the data related to surgical intervention are summarized in Table 1, Table 2. As is observed, the measurements of both groups were comparable.
Atrial fibrillation occurred in 44 of 253 patients (17.46%). When comparing both groups, a significant difference in the incidence of AF was found (atenolol 22% vs sotalol 10%; p = 0.013). Therapeutic efficiency and efficacy was 12% and 54%, respectively.
Figure 1 illustrates the
Comment
Atrial fibrillation is the most commonly occurring postcardiac surgery complication. Paradoxically its incidence has increased in recent years despite the advances in anesthesia, surgical technique and drug therapy. It has been postulated that the advanced age of patients undergoing cardiac surgery may explain this fact. Currently, no strategy is universally accepted for the prevention of AF after cardiac surgery.
Various studies, including two meta-analyses, have reported that BBs reduce the
References (30)
- et al.
Atrial fibrillation after bypass surgerydoes the arrhythmia or the characteristics of the patients prolong hospital stay?
Chest
(1998) - et al.
Atrial fibrillation after cardiac operationrisks, mechanisms, and treatment
Ann Thorac Surg
(2000) - et al.
The combination of propanolol and magnesium does not prevent postoperative atrial fibrillation
Ann Thorac Surg
(2000) - et al.
Effectiveness of sotalol in preventing supraventricular tachyarrhythmias shortly after coronary artery bypass grafting
Am J Cardiol
(1991) - et al.
Prevention of supraventricular tachyarrhythmias after open operative by low-dose sotalola prospective, double-blind, randomised, placebo-controlled study
Ann Thorac Surg
(1997) - et al.
Prophylaxis of supraventricular and ventricular arrhythmias after coronary artery bypass grafting with low-dose sotalol
Ann Thorac Surg
(2000) - et al.
Prevalence of atrial fibrillation in elderly subjects (the cardiovascular health study)
Am J Cardiol
(1994) Etiology and complications of atrial fibrillationinsights from pathology studies
Am J Cardiol
(1998)A perspective of postoperative atrial fibrillation in cardiac operation
Ann Thorac Surg
(1993)- et al.
Tachyarrhythmias and triggering factors for atrial fibrillation after coronary artery bypass operations
Ann Thorac Surg
(2000)
Multicenter trial of sotalol for suppression of frequent, complex ventricular arrhythmiasa double-blind, randomized, placebo-controlled evaluation of two doses
J Am Coll Cardiol
Atrial arrhythmias after cardiothroracic surgery
N Engl J Med
Meta-analysis of the effectiveness of prophylactic drug therapy in preventing supraventricular arrhythmia early after coronary artery bypass grafting
Am J Cardiol
Efficacy and safety of low dose propranolol versus diltiazem in the prophylaxis of supraventricular tachyarrhythmia after coronary artery bypass grafting
Eur J Cardiothorac Surg
Cited by (39)
Which beta-blocker should be used for the prevention of postoperative atrial fibrillation in cardiac surgery? A multi-treatment benefit-risk meta-analysis
2016, Egyptian Heart JournalCitation Excerpt :The electronic searches yielded 140 potentially relevant studies, of which 110 potentially eligible articles were reviewed after duplicates were removed (Fig. 1). After screening the remaining articles and selecting those that met our criteria, we included 16 trials17–32 published between 1990 and 2013 for the multiple-treatment meta-analysis investigating the following 6 oral beta-blocker regimes in the prevention of POAF: atenolol,27,32 betaxolol,22 carvedilol,17,21,23,28 metoprolol,17–19,21–25,28 propranolol30 and sotalol.18,20,24,26,27,29–31 Fig. 2 shows the network of eligible comparisons for the multiple-treatments meta-analysis.
New-Onset Atrial Fibrillation after Cardiac Surgery: Pathophysiology, Prophylaxis, and Treatment
2016, Journal of Cardiothoracic and Vascular AnesthesiaMyocardial revascularization
2011, Revista Portuguesa de CardiologiaThe efficacy of sotalol in preventing postoperative atrial fibrillation: A meta-analysis
2011, American Journal of MedicineCitation Excerpt :Existence of publication bias was evaluated by using the funnel plot method. There were 15 randomized clinical trials that provided data for 20 comparisons on the efficacy of sotalol compared with a control group for the prevention of supraventricular tachyarrhythmias after cardiac surgery.6-20 The study characteristics (summarized in Table 1) included treatment interventions, mode of electrocardiogram monitoring, primary end points (presence or absence of atrial fibrillation, definition of supraventricular tachyarrhythmia), and dosing regimens of the treatment interventions.
Atrial fibrillation after cardiac surgery: Risk factors and their temporal relationship in prophylactic drug strategy decision
2008, International Journal of CardiologyCitation Excerpt :Prophylactic strategies directed toward reduction of postoperative AF have mainly focused on antiarrhythmic drugs. Amiodarone and β-blockers have been found to reduce but not abolish this postoperative arrhythmia [6,14,15]. Several patients still experience AF despite prophylactic therapy, and a large number of the remaining patients are unnecessarily exposed to such drugs with potential adverse events.
Optimal β-blocker for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery: Carvedilol versus metoprolol
2007, Heart RhythmCitation Excerpt :In this study, AF occurred in 16% of patients who received sotalol and in 32% of those who received metoprolol (P <.01). In another study, Sanjuan et al30 compared the efficacy of oral sotalol (160 mg/d, n = 100) and oral atenolol (50 mg/d, n = 153) in 253 patients scheduled to undergo cardiac surgery. A significant difference was found in the occurrence of AF in the atenolol group (34 patients, 22%) compared with those receiving sotalol (10 patients, 10%; P = .013).