title: Feasibility of landiolol and bisoprolol for prevention of atrial fibrillation after coronary artery bypass grafting: a pilot study.
abstract: BACKGROUND
  We previously performed a trial of intravenous landiolol hydrochloride during and after cardiac surgery (the PASCAL trial) and demonstrated a preventive effect on postoperative atrial fibrillation (AF). In the present study, we investigated the efficacy of increasing the dose and administration period of landiolol for prevention of postoperative AF, as well as the effect of oral bisoprolol in the early postoperative period.
  
  
  METHODS
  A total of 105 patients who underwent coronary artery bypass grafting were randomized to 3 groups: a group receiving intravenous landiolol perioperatively at 5 μg/kg/min for 3 days (group L), a group receiving oral bisoprolol postoperatively together with landiolol (group LB), and a control group without beta-blocker therapy (group C). The primary end point was the presence/absence of postoperative AF. Secondary end points were (1) the early clinical outcome, (2) hemodynamics, (3) cardiac enzymes (creatine kinase isoenzyme MB, troponin-I, and human heart fatty acid-binding protein), (4) high-sensitivity C-reactive protein (hs-CRP) and pentraxin-3, (5) asymmetric dimethylarginine (ADMA), and (6) brain natriuretic peptide.
  
  
  RESULTS
  Postoperative AF occurred in 14.5% of group L, 9.1% of group LB, and 35.3% of group C. A significant difference was observed between groups LB and C. Significantly higher levels of troponin-I, human heart fatty acid-binding protein, hs-CRP, pentraxin-3, and ADMA were noted in group C than in groups L and LB.
  
  
  CONCLUSIONS
  Landiolol and bisoprolol prevented postoperative AF. The anti-ischemic, anti-inflammatory, and anti-oxidant effects of these beta-blockers presumably inhibited the onset of AF.
authors.affiliation: Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. asezai.med@gmail.com
authors.forename: Akira
authors.initials: A
authors.lastname: Sezai
authors.forename: Tishiko
authors.initials: T
authors.lastname: Nakai
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Hata
authors.forename: Isamu
authors.initials: I
authors.lastname: Yoshitake
authors.forename: Motomi
authors.initials: M
authors.lastname: Shiono
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kunimoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000975:Antioxidants / Q000008:administration & dosage; D001120:Arginine / Q000031:analogs & derivatives / Q000097:blood; D001281:Atrial Fibrillation / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D015415:Biomarkers / Q000097:blood; D017298:Bisoprolol / Q000008:administration & dosage*; D002097:C-Reactive Protein / Q000378:metabolism; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D052279:Creatine Kinase, MB Form / Q000097:blood; D004334:Drug Administration Schedule; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007564:Japan; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010865:Pilot Projects; D000683:Serum Amyloid P-Component / Q000378:metabolism; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D014508:Urea / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000099153:Pentraxins
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D000893:Anti-Inflammatory Agents; D000975:Antioxidants; D001120:Arginine; D015415:Biomarkers; D017298:Bisoprolol; D002097:C-Reactive Protein; D052279:Creatine Kinase, MB Form; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D009025:Morpholines; D020097:Natriuretic Peptide, Brain; D000683:Serum Amyloid P-Component; D019210:Troponin I; D014508:Urea; D000099153:Pentraxins; C493408:FABP3 protein, human; C077049:landiolol; C018524:N,N-dimethylarginine