Preoperative beta-blocker use reduces atrial fibrillation in off-pump coronary bypass surgery.
BACKGROUND
Atrial fibrillation (AF) after coronary artery bypass graft surgery constitutes the most common sustained arrhythmia and results in many complications. The purpose of this study was to assess the effects of prophylactic use of beta-blockers against atrial fibrillation in off-pump surgery patients in the early postoperative period.


METHODS
From 2002 to 2005, 78 patients were enrolled and 41 patients received 50 mg metoprolol succinate daily, which was initiated minimum four days before surgery. Preoperative beta-blocking therapy was continued until the morning of surgery. Thirty-seven patients were free of beta-blocker therapy. Esmolol was used within same range of doses in both groups during operations. Both groups received metoprolol succinate following operations. The frequency of AF occurrence was analysed from the operation time to the sixth postoperative day.


RESULTS
Sixteen patients developed AF with an overall incidence of 22.5%. Four patients from the study group and three patients from the control group were excluded from the study because of transfer to on-pump surgery. There was no difference with regard to the number of grafts carried out, duration of operations and ventilation, intensive care unit stay and inotropic need among groups. Length of hospital stay did not differ among groups either. There was a higher incidence of postoperative AF in patients without beta-blocker prophylaxis (11.7-32.4% P=0.049).


CONCLUSIONS
Low-dose postoperative beta-adrenergic blockade is valuable for patients who receive these medications before off-pump coronary artery bypass grafting procedures and may be beneficial against AF in all patients.
Imren
Yildirim
Y
Division of Cardiothoracic Surgery, Columbia University Medical Center - New York Presbyterian Hospital, New York, NY, USA. yimren@gazi.edu.tr
Benson
Ariel A
AA
Zor
Hakan
H
Tasoglu
Irfan
I
Ereren
Emrah
E
Sinci
Volkan
V
Gokgoz
Levent
L
Halit
Velit
V
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D008790:Metoprolol