Intravenous Administration of Metoprolol Is More Effective Than Oral Administration in the Prevention of Atrial Fibrillation After Cardiac Surgery (original) (raw)
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International Journal of Cardiology, 2008
Atrial fibrillation (AF) occurs frequently after coronary artery bypass grafting (CABG) and often results in prolonged postsurgical hospital stays and increased mortality and morbidity. Beta blockers are known to prevent postoperative AF. In this prospective study, we investigated the efficacy of carvedilol compared with metoprolol succinate in preventing postoperative AF.Subjects included 110 patients (31 women, 79 men; mean age, 60 ± 10 years, range, 39–82 years) who had undergone CABG. Patients were randomized to receive either metoprolol or carvedilol, and all patients received the drugs 3 days prior to surgery. Metoprolol was started at 50 mg twice daily and carvedilol was started at 12.5 mg twice daily. The doses were titrated according to the patients' hemodynamic responses. All patients were monitored for 3 days after the surgery.Of the 110 patients, 55 (50%) were treated with metoprolol succinate, and 55 (50%) were treated with carvedilol. Baseline characteristics and operative data of the patients did not differ between groups. During follow-up, 20 patients (36%) in the metoprolol group and 9 patients (16%) in the carvedilol group developed AF (P = 0.029). Multiple stepwise logistic regression analysis showed that metoprolol use, older age, and impaired left ventricular ejection fraction were independent risk factors for developing AF, and carvedilol use was found to be independently related to sinus rhythm maintenance after CABG (P = 0.02).These results show that carvedilol is superior to metoprolol in decreasing development of early postoperative AF.
International cardiovascular research journal, 2014
Atrial Fibrillation (AF) is a common complication after open heart surgery and is frequently associated with increased hospital stay, complications, and mortality rates. The effect of β-blockers on prevention of supraventricular arrhythmias has been confirmed in several prospective randomized studies. This clinical trial aimed to compare the preventive effects of carvedilol and metoprolol on occurrence of AF after CABG surgery. This prospective, double-blind, randomized clinical trial was conducted on 150 patients (55 females, 95 males; mean age: 59 ± 10 years) who underwent CABG surgery. The patients with no contraindication for β-blocker use were randomly divided into two groups of carvedilol and metoprolol Tartarate (n = 75). Treatment with β-blocker was started on the first postoperative day (metoprolol, 25 mg BD; carvedilol, 6.25 mg, BD) and the dosage was regulated according to the patients' hemodynamic response. All the patients were monitored 5 days after the surgery and...
European Heart Journal, 2013
Carvedilol and N-acetyl cysteine (NAC) have antioxidant and anti-inflammatory properties. Aim was to evaluate the efficacy of metoprolol, carvedilol, and carvedilol plus NAC on the prevention of post-operative atrial fibrillation (POAF). Methods and results Patients undergoing cardiac surgery (n ¼ 311) were randomized to metoprolol, carvedilol, or carvedilol plus NAC. Baseline characteristics were similar. The incidence of POAF was lower in the carvedilol plus NAC group compared with the metoprolol group (P , 0.0001) or the carvedilol group (P ¼ 0.03). There was a borderline significance for lower POAF rates in the carvedilol group compared with the metoprolol group (P ¼ 0.06). Duration of hospitalization was lower in the carvedilol plus NAC group compared to the metoprolol group (P ¼ 0.004). Multivariate independent predictors of POAF included left-atrial diameter, hypertension, bypass duration, pre-randomization and preoperative heart rates, carvedilol plus NAC group vs. metoprolol group, and carvedilol plus NAC group vs. carvedilol group. Conclusion Carvedilol plus NAC decreased POAF incidence and duration of hospitalization compared with metoprolol and decreased POAF incidence compared with carvedilol.
2021
Background: The optimal therapeutic strategy for high-risk postoperative atrial fibrillation (POAF) remains less well defined. Our objectives were to investigate the efficacy of prophylactic metoprolol versus low-dose sotalol regimens to prevent high-risk atrial fibrillation (AF) following coronary artery bypass surgery (CABG). Methods: We assigned 113 consecutive patients referred for CABG to either metoprolol or low-dose sotalol regimen. The primary end-point was the frequency of POAF during the 6-week follow-up. Results: Out of 113 patients enrolled, 52.2% % received metoprolol (n= 59) while 44.8% received sotalol (n= 54). The frequency of POAF at follow-up was significantly higher among the metoprolol group (59.3 % versus 50 %; P=0.017). The predictors of POAF were: age > 60 years (OR: 1.86 (1.01-4.41); P= 0.03), EF (OR: 2 (1.05-3.83); P= 0.02), and sotalol was protective against POAF (OR= 0.49%; (95% CI=0.25 -0.97); P=0.02). The length of hospital stay was significantly high...
Current Vascular Pharmacology, 2014
Atrial fibrillation (AF) after isolated coronary surgery in many aspects remains an unsolved issue and a source of morbidity . Postoperative AF (POAF) has significant adverse effects and prolongs hospital stay, leading to relevant disease burden and medical costs . Its consequences are substantial: this arrhythmia dramatically increases early and late mortality . Patients affected by POAF are at risk of fatal embolic events, therefore, a strict postoperative surveillance is widely recommended .
2020
Postoperative atrial fibrillation is a very common surgical complication encountered in patients undergoing Cardiac Surgery including Coronary Artery Bypass Grafting and Valvular Surgeries, which leads to increase hospital stay and burden on health care providers. The aim of this review study was to to determine the effectiveness of current management for the Prophylaxis of Postoperative Atrial Fibrillation in Cardiac Surgeries and to propose a possible prophylaxis to prevent POAF. 21 research papers were selected and brought under review after carefully considering the current day evidence for prophylaxis and each having its scientific evidence and background. The papers were carefully reviewed and findings were given in favour of Amiodarone, Ascorbate and B-Blockers including Sotalol. This can rightly be concluded from this study that prophylaxis with Ascorbate for 5 days prior to cardiac surgery along with the use of Amiodarone 1.2 g before surgery and 600 mg/day till 3rd post op...
Preoperative use of sotalol versus atenolol for atrial fibrillation after cardiac surgery
Annals of Thoracic Surgery, 2004
Background. Atrial fibrillation is one of the most common complications of cardiac surgery. Beta blockers have been demonstrated to decrease the incidence of postoperative atrial fibrillation. Preliminary investigations reporting sotalol and atenolol to be effective in preventing postoperative atrial fibrillation are encouraging, but no studies have been conducted comparing both drugs.
International Journal of Cardiology, 2009
Postoperative atrial fibrillation (AF) occurs in up to 50% of patients undergoing coronary artery bypass (CABG) surgery and is associated with complications. Amiodarone and beta blockers are effective as prophylaxis for AF after CABG. The purpose of this study was to compare oral amiodarone versus oral bisoprolol for prevention of AF after CABG. In this randomized study, 200 patients admitted for elective CABG were given oral amiodarone (n=98 patients) or oral bisoprolol (n=102 patients) beginning 6 h after surgery. Amiodarone patients received 15 mg/Kg then 7 mg/Kg/day for one month. Bisoprolol patients received 2.5 mg then 2.5 mg bid indefinitely. Postoperative AF occurred in 15.3% of the patients in the amiodarone group and 12.7% of the patients in the bisoprolol group (p=0.60). Maximal ventricular rate tended to be lower in the bisoprolol group (125+/-6 beats/min) compared with the amiodarone group (144+/-7 beats/min, p=.06). Preoperative beta blockage did not affect AF incidence in either study group. There was no difference between the 2 groups for the onset time of AF episodes, total AF duration, AF recurrence and postoperative length of hospital stay. No serious postoperative complications occurred in the two study groups. Two reversible low cardiac output cases occurred with bisoprolol. Postoperative oral bisoprolol and amiodarone are equally effective for prophylaxis of AF after CABG. Treatment with bisoprolol resulted in a trend to lower ventricular response rate in AF cases. Both regimens were well tolerated.
The Heart Surgery Forum, 2008
Background. We investigated the effects of preoperative administration of beta-blockers on the incidence of atrial fibrillation (AF) after cardiothoracic surgery and the resulting morbidity and mortality. Methods. We retrospectively evaluated 181 patients who underwent operations between May 2004 and December 2007. We divided the patients into 2 groups according to their preoperative use beta-blockers. Group A (n = 89) consisted of patients who did not receive beta-blockers, and group B (n = 92) consisted of patients who received 50 mg metoprolol succinate daily. All patients underwent on-pump coronary artery bypass grafting (CABG) via sternotomy. Results. Atrial sizes and the baseline clinical and laboratory data were similar for the 2 groups. The 2 groups were also similar with respect to the numbers of grafts per patient, preoperative ejection fractions, cross-clamp times, cardiopulmonary bypass times, and postoperative inotrope use (P > .05). AF occurred in 39 (21.5%) of the 181 patients after the operation. Postoperative AF occurred in 30 (33.7%) of the group A patients and in 9 patients (9.7%) in group B (P < .05). Conclusion. Postoperative AF increases the rates of morbidity and mortality and the length of hospital stay after CABG. The prophylactic use of beta-blockers decreases the rate of postoperative AF and thus AF-related complications.
International Journal of Cardiology, 2009
Although all beta blockers appear to be effective in the prevention of postoperative atrial fibrillation (AF) following coronary artery bypass surgery (CABG), carvedilol was found to be much more effective than metoprolol in this respect as the current study clearly delineated. We believe that the ongoing COMPACT trial will answer the question of whether or not carvedilol is more superior than metoprolol to prevent postoperative AF in patients undergoing CABG.