Landiolol hydrochloride for prevention of atrial fibrillation after coronary artery bypass grafting: new evidence from the PASCAL trial.
OBJECTIVE
Atrial fibrillation occurs frequently after cardiac surgery and not only prolongs hospitalization but also influences the prognosis. We investigated whether landiolol hydrochloride, an ultrashort-acting beta-blocker, could reduce postoperative atrial fibrillation in a randomized controlled trial.


METHODS
The subjects were 140 patients undergoing coronary artery bypass grafting at the Nihon University School of Medicine. The primary end point was occurrence/non-occurrence of atrial fibrillation up to 1 week postoperatively. Logistic regression analysis was performed to investigate risk factors for atrial fibrillation among preoperative, perioperative, and postoperative variables.


RESULTS
Atrial fibrillation occurred in 7 patients (10%) in the landiolol group versus 24 patients (34.3%) in the placebo group; the landiolol group had a significantly lower incidence (P = .0006). Postoperative heart rate was significantly lower in the landiolol group than in the placebo group. On returning to the intensive care unit, the landiolol group had significantly lower inflammatory and ischemic parameters. Medical costs were also significantly lower in the landiolol group. Multivariate analysis revealed that significant risk factors for atrial fibrillation were a European System for Cardiac Operative Risk Evaluation of 10 or more, preoperative non-use of angiotensin receptor blockers, and non-use of landiolol.


CONCLUSIONS
Postoperative atrial fibrillation was reduced by treatment with landiolol hydrochloride. Amelioration of ischemia, an anti-inflammatory effect, and inhibition of sympathetic hypertonia by landiolol presumably reduced the occurrence of atrial fibrillation. Hypotension or bradycardia did not develop in any of the patients, indicating the safety of this beta-blocker. These findings suggest that landiolol hydrochloride could be useful in the perioperative management of patients undergoing cardiac surgery.
Department of Cardiovascular Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan. asezai@med.nihon-u.ac.jpa
Akira
A
Sezai
Kazutomo
K
Minami
Toshiko
T
Nakai
Mitsumasa
M
Hata
Isamu
I
Yoshitake
Shinji
S
Wakui
Motomi
M
Shiono
Atsushi
A
Hirayama
D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use*; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000191:economics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000191:economics / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000191:economics; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D016527:Drug Costs; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D017721:Hospital Costs; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000191:economics / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014508:Urea / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D009025:Morpholines; C077049:landiolol; D014508:Urea