The use of atenolol in the prevention of supraventricular arrhythmias following coronary artery surgery

Abstract

Sixty patients undergoing coronary artery bypass surgery were studied prospectively in order to investigate the effect of a cardioselective beta-blocker on the incidence of postoperative supraventricular arrhythmias. Patients with good left ventricular function were randomly divided into two groups: 30 patients treated with atenolol and 30 patients acting as controls. Atrial fibrillation was seen in 11 patients and frequent premature atrial extrasystoles were noted in one. Eleven (37%) patients in the control group experienced arrhythmias whilst atenolol significantly reduced this incidence to 3% (one patient), P = 0.001. There was no significant relationship between the development of supraventricular arrhythmias and the following variables: age, sex, severity of preoperative symptoms, previous myocardial infarction, extent of coronary artery disease, technique of myocardial preservation used, ischaemic time, number and site of saphenous vein grafts, endarterectomies performed and perioperative serum potassium levels. It is concluded that the use of atenolol (started 72 h before operation) is effective in reducing the incidence of supraventricular arrhythmias following elective coronary artery bypass operations in patients with good left ventricular function.

Post-operative atrial fibrillation: a maze of mechanisms

“…Withdrawal from and treatment with β-blockers has been shown to largely affect POAF incidence, 50,117–119 while reducing oxidative stress, 124,135 or inflammation 86,87 were less effective. In line with this the 2010 European Society of Cardiology guidelines recommend β-blocker treatment as first-line therapy of POAF.…”

“…Indeed, patients receiving β-blockers post-operatively have fewer episodes of AF compared with patients receiving placebo. 50,117,118 However, these results must be interpreted with caution as arrhythmia detection varies between studies and some of the patients, assigned to the placebo group, were withdrawn from their pre-operative β-blocker therapy. 105 The withdrawal of pre-operative β-blockade after CABG is associated with a more than two-fold increase in POAF.…”

Atrial fibrillation post cardiac surgery trends toward management

“…These drugs are primary in AF prevention and should be used routinely in every patient. [2829] Several clinical trials have evaluated the effect of various beta-blockers on the incidence of POAF,[30–32] and the results indicate an overall reduction of this complication. However, it should be noted that even in recent large trials where this strategy has been widely applied, the incidence of POAF remains nearly 60% in selected patients.…”

Pharmacologic prophylaxis for atrial fibrillation following cardiac surgery: a systematic review

“…Lamb et al, randomized 60 patients underwent CABG treated with atenolol or not. Remarkably, 37% of patients in control group experienced a sypraventricular arrhythmia compared to 3% in atenolol group (p = 0.001) [29]. Several studies compared the efficacy of iv or oral b-blocker as well as different types of b-blocker.…”