Combination therapy for prevention of atrial fibrillation after coronary artery bypass surgery: a randomized trial of sotalol and magnesium.
OBJECTIVE
Atrial Fibrillation (AF) is a common complication of coronary artery bypass surgery reported to occur in 20-40% of patients. Sotalol alone and magnesium alone have been shown to decrease the incidence of AF. The aim of this study was to evaluate the efficacy of these two agents, alone or in combination, to reduce postoperative AF.


METHODS
Two hundreds and seven consecutive coronary artery bypass patients were randomized to receive sotalol alone (80 mg two times daily for five days starting from the morning of the first postoperative day), magnesium alone (1.5 g daily for six days starting in the operating room just before cardiopulmonary bypass), both pharmacological agents at the same dosages or no antiarrhythmic agents (Control group). Patients with an ejection fraction <40% were excluded.


RESULTS
The incidence of postoperative AF was 11.8% (6/51) in the sotalol group, 14.8% (8/54) in the magnesium group, 1.9% (1/52) in sotalol+magnesium group and 38% (19/50) in the control group. The differences were significant between the control group and the other three groups (sotalol, magnesium and sotalol + magnesium groups: p = 0.002, p = 0.007 and p < 0.0001 respectively), and between the sotalol + magnesium group and single drug groups (sotalol and magnesium groups: p = 0.04 and p = 0.01, respectively.


CONCLUSIONS
The incidence of AF after coronary surgery was significantly reduced by the administration of sotalol alone and magnesium alone. The incidence of postoperative AF was further reduced by combining the two pharmacological agents.
Forlani
Stefano
S
Cattedra di Cardiochirurgia, University of Rome Tor Vergata, European Hospital, Via Portuense 700, 00149 Rome, Italy. hhstel@tiscali.it
Moscarelli
Marco
M
Scafuri
Antonio
A
Pellegrino
Antonio
A
Chiariello
Luigi
L
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D001026:Coronary Artery Bypass; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008274:Magnesium / Q000097:blood / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D011237:Predictive Value of Tests; D013015:Sotalol / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D008274:Magnesium