Beta blockade to prevent atrial dysrhythmias following coronary bypass surgery

Paull, Daniel L.; Tidwell, Sandra L.; Guyton, Steven W.; Harvey, Eric; Woolf, Roger; Holmes, John; Anderson, Richard P.

doi:10.1016/s0002-9610(97)00077-9

Cited by 29 publications

(21 citation statements)

References 20 publications

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“…Our result was consistent with a recent study conducted at a single center that failed to confirm the benefits from preoperative f3-blockade on clinical outcome in patients undergoing cardiovascular surgery. 29 The potential role of multiple concurrent medications (adjunct to ACE inhibitors) to modify clinical outcome after cardiovascular surgery requires further validation in a study with a larger cohort. CONCLUSION Preoperative therapy with ACE inhibitors did not influence the clinical outcome after cardiovascular surgery.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Preoperative Therapy With Angiotensin-Converting Enzyme Inhibitors on Clinical Outcome After Cardiovascular Surgery

Rady

Ryan

1998

Chest

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Section: Discussionmentioning

confidence: 99%

The Effects of Preoperative Therapy With Angiotensin-Converting Enzyme Inhibitors on Clinical Outcome After Cardiovascular Surgery

Rady

Ryan

1998

Chest

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“…Janssen et al (14) konnten 1988 eine Abnahme der Inzidenz von SVA unter Metoprololgabe um mehr als 60 % erzielen. Paull et al (22) randomisierten zwischen 1990 und 1995 100 Bypass-Patienten in eine Metoprolol-und Placebogruppe, wobei primär kein signifikanter Unterschied in der Häufigkeit von SVA gezeigt werden konnte. Jedoch traten nach Änderung der kardioprotektiven Maßnahmen während der Studie signifikant weniger SVA auf.…”

Section: Diskussionunclassified

“…Die Wirksamkeit von Elektrolytsubstitution und Antiarrhythmika verschiedener Klassen ist in zahlreichen Studien untersucht worden (8,9,10,13). Die bedeutendste Rolle spielten dabei die β-Rezeptor-Antagonisten, die sowohl in der Prophylaxe als auch in der Therapie der SVA wirksam waren (1, 18,21,22,23,24). Nach kardiochirurgischen Eingriffen mit der Herz-Lungen-Maschine wird jedoch in der postoperativen Phase aufgrund von Hypovolämie und Hypotonie in der Regel von der Applikation sämtlicher Antihypertensiva Abstand genommen.…”

Section: Introductionunclassified

Wirksamkeit der Metoprolol-Therapie in der Prävention supraventrikulärer Arrhythmien nach koronarer Bypass-Operation

et al. 1999

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Atrial fibrillation is in 20-50% the most frequent dysrhythmia after coronary artery bypass grafting (CABG) and a possible cause for hemodynamical complications and prolongation off the medical treatment in patients. Therefore, the effect of beta-blocking with metoprolol for prevention of supraventricular arrhythmias (SVA) was investigated in a prospective and randomized trial. 200 patients after CABG were randomized in a drug and control group (average age 63.2 years, 154 male, 46 female). Patients of the drug group (n=100) were treated with metoprolol (1mg/kg/BW) beginning on day one after operation, whereas patients of the control group (n=100) received therapy only in case of occurrence of atrial fibrillation. ECG, blood pressure, and electrolyte concentrations were measured regularly until the tenth day after surgery. Reasons for exclusion were an ejection fraction (< 30%, SA- and AV-block or simultaneous application of epinephrine and metoprolol. There were no significant differences between the patients of drug and control group with respect to age, sex ejection fraction, previous medication, number and type of bypass grafts, cardiopulmonary bypass time, and perioperative ischemic events. However, a statistically significant difference was seen in the occurrence of supraventricular arrhythmias in both groups, 4 patients of the therapy group (4%) in contrast to 37 patients of the control (37%) developed supraventricular arrhythmias during the postoperative observation period (p<0.0001). Both groups differed in total time of hospital stay by 1.5 days (control group: 9.83+/-2.88 days; drug group: 8.42+/-2.81 days), which was statistically significant (p<0.05). All patients of the drug group could be discharged with a stable sinus rhythm, whereas 7 patients of the control group were discharged with persistent atrial fibrillation. The difference was statistically significant as well (p<0.01). Neither typical side effects of metoprolol, nor AV-blocks, bradycardia (f<60/min) or symptoms of low blood pressure could be observed. The conclusion of this trial is a recommendation for a preventive application of 50mg metoprolol/day after coronary artery bypass surgery, which can reduce the incidence of SVA as well as the hospital stay statistically significant.

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“…'~~~ In addition, prophylaxis for AFlB by initiating treatment with agents that are conventionally used to treat AFIB, such as digitalis, beta blockers, procainamide, and amiodarone, has also been recommended as a method to lower the incidence of AFIB, but has never been uniformly accepted and validated as a reliable method. [16][17][18][19][20] We believe that because of the likely multifactorial etiology of postoperative AFIB, it is important to utilize a multidrug prophylaxis for lowering the incidence of AFlB and that early detection of atrial rhythm instability and initiation of treatment with procainamide are relevant in reducing the incidence of postoperative AFIB. consequently, we developed and applied a muttidrug prophylaxis to a consecutive series of patients undergoing isolated CABG with the goal of reducing the incidence of postoperative AFIB.…”

Section: Introductionmentioning

confidence: 99%

Reduced Postoperative Atrial Fibrillation Using Multidrug Prophylaxis

Ott

Gutfinger

Alimadadian

et al. 2010

Journal of Cardiac Surgery

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Background: Atrial fibrillation (AFIB) is t h e most common complication following coronary artery bypass grafting (CABG). Despite three decades of recognition, efforts t o reduce t h e high incidence reported (15%-30%) have been largely unsuccessful. Reasons for postoperative AFlB are likely multifactorial. As a result, w e defined a multidrug prophylaxis based on agents known t o b e individually effective. This method was applied prospectively t o a series of consecutive CABG patients with the goal of reducing t h e incidence of new-onset postoperative AFIB. Methods: Isolated CABG with cardiopulmonary bypass was performed o n 517 consecutive patients. A rapid recovery protocol emphasizing AFlB multidrug prophylaxis was applied to all patients. All patients received 10 p g of triiodothyronine intraoperatively when the clamp on the aorta was released. Immediately following CABG, parenteral magnesium was administered t o assure a serum magnesium > 130 mmHg were begun on beta blocker therapy (metoprolo125 mg-100 mg/day). In particular,

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Beta blockade to prevent atrial dysrhythmias following coronary bypass surgery

Cited by 29 publications

References 20 publications

The Effects of Preoperative Therapy With Angiotensin-Converting Enzyme Inhibitors on Clinical Outcome After Cardiovascular Surgery

The Effects of Preoperative Therapy With Angiotensin-Converting Enzyme Inhibitors on Clinical Outcome After Cardiovascular Surgery

Wirksamkeit der Metoprolol-Therapie in der Prävention supraventrikulärer Arrhythmien nach koronarer Bypass-Operation

Reduced Postoperative Atrial Fibrillation Using Multidrug Prophylaxis

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