Beta-blocker prophylaxis for atrial fibrillation after coronary artery bypass grafting in patients with sympathovagal imbalance.
BACKGROUND
Atrial fibrillation (AF) is the most common arrhythmia after coronary bypass grafting (CABG) resulting in a prolonged hospital stay and higher costs. The withdrawal of beta-blocker and a sympathovagal imbalance were identified as risk factors for AF.


METHODS
In our study we performed a measuring of standard deviation of all normal RR intervals (SDNN) among 142 consecutive patients with beta-blocker therapy before CABG in order to identify a collective who had an increased risk due to a withdrawal of beta-blocker medication. A sympathovagal imbalance was predefined as a SDNN below 30 ms. Patients were divided into four groups according to the results of SDNN and the continuous beta-blocker therapy: group I: SDNN < or = 30 ms or less and withdrawal of beta-blocker therapy (26 patients); group II: SDNN < or = 30 ms and continuously beta-blocker therapy (33 patients); group III: SDNN > 30 ms and withdrawal of beta-blocker therapy (40 patients); group IV: SDNN > 30 ms and continuous beta-blocker therapy (43 patients).


RESULTS
Atrial fibrillation occurred in 39 patients (27%) after surgery. Patients of group I showed a higher incidence of AF (14 of 26 patients, 54%) than patients of group II (7 of 33 patients, 21%; p < 0.009), patients of group III (8 of 40 patients, 20%; p < 0.004), or patients of group IV (10 of 43 patients, 23%; p < 0.01). We found a significantly higher incidence of diabetes mellitus (47 vs 14% of patients; p < 0.0001) in patients with a sympathovagal imbalance than patients with a SDNN above 30 ms.


CONCLUSIONS
The results of our study suggest a sympathovagal imbalance and withdrawal of a beta-blocker therapy increase the risk of postoperative AF. A continuous beta-blocker therapy reduces the risk especially in patients with a sympathovagal imbalance and should always be practiced.
Budeus
Marco
M
Department of Cardiology, West-German Heart Centre, University of Duisburg-Essen, Essen, Germany. marco.budeus@medizin.uni-essen.de
Feindt
Peter
P
Gams
Emmeran
E
Wieneke
Heinrich
H
Sack
Stefan
S
Erbel
Raimund
R
Perings
Christian
C
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001281:Atrial Fibrillation / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014630:Vagus Nerve / Q000503:physiopathology*
D000319:Adrenergic beta-Antagonists