Original article: cardiovascular
Preoperative use of sotalol versus atenolol for atrial fibrillation after cardiac surgery

https://doi.org/10.1016/j.athoracsur.2003.06.014Get rights and content

Abstract

Background

Atrial fibrillation is one of the most common complications of cardiac surgery. Beta blockers have been demonstrated to decrease the incidence of postoperative atrial fibrillation. Preliminary investigations reporting sotalol and atenolol to be effective in preventing postoperative atrial fibrillation are encouraging, but no studies have been conducted comparing both drugs.

Methods

A total of 253 consecutive eligible patients (66 ± 8 years; mean ± standard deviation) scheduled to undergo cardiac surgery were enrolled in this study. Patients were randomized in a prospective open manner 1.5:1 to atenolol group (50 mg/daily; 153 patients) or sotalol group (80 mg twice daily; 100 patients).

Results

Atrial fibrillation occurred in 44/253 patients (17.45%). A significant difference was found in the occurrence of atrial fibrillation in the atenolol group (34 patients, 22%) compared with those receiving sotalol (10 patients, 10%; p = 0.013). Therapeutic efficiency and efficacy was 12% and 54%, respectively. Stepwise logistic regression analysis revealed that age more than 68 years old (odds ratio = 2.72; 95% confidence interval [CI] = 1.37–5.41; p = 0.004), the use of β-adrenergic agents (odds ratio = 2.74; 95% CI = 1.5–5; p = 0.001), and sotalol (odds ratio = 0.46; 95% CI = 0.23–0.95; p = 0.035) were independently associated with development of atrial fibrillation.

Conclusions

Oral low-dose sotalol provides a considerable reduction in the occurrence of atrial fibrillation. A selective approach based on clinical risk prediction should decrease the occurrence of 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

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