Beta-blocker effects on postoperative atrial fibrillation (original) (raw)
Related papers
Annals of Noninvasive Electrocardiology, 2013
Background: Atrial fibrillation/flutter (AF) is a common complication of open heart surgery and ACC/AHA guidelines strongly recommend the use of prophylactic beta-blockers (BB) for its prevention. Several recent studies, however, have failed to show the desired protective effects of BB against post-coronary artery bypass grafting (CABG) AF. As the protocols of CABG, medical management of CAD (coronary artery disease) and demographic features of the patients undergoing open heart surgery have evolved significantly over the last two decades, we decided to perform a review of evidence from latest randomized controlled trials (RCTs) to confirm the efficacy of prophylactic BB. Methods: We searched for RCTs comparing the efficacy of prophylactic BB versus placebo/control against post-CABG AF. We limited our search to 1995 till present to reflect ongoing advancements in the protocols of CABG and the medical management of CAD. Initially, 34 trials were selected; however after certain exclusions only 10 RCTs were included in the final analysis. Results: Prophylactic BB decreased the incidence of post-CABG AF from 32.8% in the control group to 20% in the prophylactic group with risk ratio (RR) of 0.50 with 95% CI of 0.36-0.69, P value < 0.001. In a subgroup analysis, carvedilol appears to be superior to metoprolol for the prevention of postoperative AF. Conclusions: Despite several limitations, this analysis confirms the efficacy of prophylactic BB against post-CABG AF in this era. We recommend continuing perioperative BB in the open heart surgery patients in the absence of contraindications.
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.
Cureus, 2021
Introduction Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is correlated with poor patient outcomes. The study evaluated the association of patients' clinical and sociodemographic characteristics with the incidence of atrial fibrillation, postoperatively. Methodology A longitudinal study was performed in the cardiology department of a tertiary care unit, Sindh, Pakistan between October 2019 and November 2020. All patients who underwent CABG surgery irrespective of gender aged 30 to 75 years were included in the study. Patients with a history of atrial fibrillation or severe left ventricular dysfunction were excluded from the study. The incidence of atrial fibrillation was determined by observing an irregular pattern on electrocardiography (ECG) with no definite P-wave and irregular R-R interval. The patients were monitored for seven postoperative days. The final outcome was measured on the seventh postoperative day. Results A total of 247 patients with a mean age of 63.43 ± 9.72 were enrolled in the study. Out of the 247 patients, 9.7% developed new-onset atrial fibrillation, postoperatively. Age above 65 years was associated with the occurrence of AF but it was not statistically significant (p>0.05). Similarly, patients who developed AF were more likely to have a left ventricle ejection fraction (LVEF) of less than 35% than those without AF (66.67% vs 43.95%; p=0.033). Conclusion A high rate of AF was observed in the study. Older age and impaired ventricular function were significantly associated with atrial fibrillation. It is recommended that hospitals should devise guidelines and protocols for the prevention and management of atrial fibrillation in patients undergoing cardiothoracic surgeries in order to minimize patient mortality and improve patient outcomes.
POST-OPERATIVE ATRIAL FIBRILLATION; INCIDENCE AFTER CORONARY ARTERY BYPASS GRAFT SURGERY
Atrial fibrillation is the most common arrhythmia observed following Coronary Artery Bypass Graft surgery. Objectives: To determine the incidence of post-operative atrial fibrillation in patients undergoing coronary artery bypass grafting. Materials and Methods: Study Design: Non-randomized prospective. Setting: Cardiac Surgery Department of Multan Institute of Cardiology, Multan. Period: 20-1-2014 to 01-05-2015. A total number of four hundred and ninety (490) patients having age more than 40 years undergoing isolated coronary artery bypass graft surgery were included in the study. Data was analyzed in SPSS V20 software. Frequency and percentages were used for Atrial Fibrillation. To see the impact of AF on morbidity, patients developing AF was compared with those who do not develop Atrial Fibrillation post-operatively using independent sample t-test for quantitative variables. Chi-square test and Fischer's Exact test (whenever appropriate) was used to compare qualitative variables. Results: A total number of four hundred and ninety (490) patients were included in this study. There were more 431 males (88.0%) in this study. of the patients 71.6% were in LV Grade I before surgery. Incidence of post-operative atrial fibrillation was 13.5%. In 4.5% patients IABP was inserted due to hemodynamic instability. Ventilation time and hospital stay time was significantly higher in patients with AF postoperatively (p value 0.03 and 0.02 respectively). But duration of inotropic support, post-op CKMB levels and IABP use were not significantly different in both groups. Conclusion: The incidence of post-operative Atrial Fibrillation is 13.5% according to this study. And these patients were associated with increased risk of morbidity.
Atrial fibrillation (AF) after coronary artery bypass graft (CABG) is a common complication with potentially higher risk of adverse outcome and prolonged hospital stay. To determine the impact of postoperative AF (POAF) on long-term outcome in a large cohort of patients who underwent CABG. We conducted an observational cohort study of 989 patients who underwent isolated CABG with more than 5-year follow-up. Patient divided in two groups: patients with and without POAF. In this study, atrial fibrillation developed after CABG in 156 patients (15.8%). Patients with POAF were generally older (P = 0.001) and presented more often with comorbidities including congestive heart failure (P = 0.001), hypertension (P = 0.001), peripheral vascular disease (P = 0.001), hyperlipidemia (P = 0.009), and renal failure (P = 0.001). Five-year mortality was observed in 23 (2.3%) patients. Patients with POAF had higher five-year mortality rate than those without POAF. Multivariate logistic analysis showe...
Predictors of Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Surgery
Indian Pacing and …, 2008
The present study was aimed to identify the preoperative, intraoperative, and postoperative predictors of AF in a pure cohort of the patients with coronary artery disease who underwent CABG surgery. Methods Between November 2005 and May 2006, 302 consecutive patients were included in this prospective study. All the relevant clinical, electrocardiographic, echocardiographic, and laboratory data were gathered in the included patients and they were also monitored for development of post-CABG AF. Results Postoperative AF occurred in 46 (15%) of patients. By univariate analysis, older age, P-wave abnormality in ECG, presence of mitral regurgitation, larger left atrium (LA), left main coronary artery involvement, failure to graft right coronary artery (RCA), and adrenergic use in ICU were significantly associated with occurrence of post-CABG AF (all P< 0.05).
Incidence And Risk Factors Of Atrial Fibrillation After Coronary Bypass Graft Surgery
2011
coronary artery bypass grafting (CABG). It is associated with an increased risk of mortality and morbidity, predisposes patients to a higher risk of stroke, requires additional treatment, and increases the costs of the post-operative care. This study aimed to determine the incidence, timing, and risk factors for AF after CABG in National Cardiovascular Centre Harapan Kita. Methods. We conducted a retrospective cohort study in 138 consecutive patients with sinus rhythm who underwent CABG. The endpoint of study was new onset in hospital AF. Results. AF developed in 36 patients (26,1%). AF occurred 2,67 ± 1,91days (range 0–7 days) after CABG with a peak incidence on postoperative day 2 and 28 patients (77%) had AF within the first 3 day after CABG. Univariate analysis showed that age ≥ 60 years (P 3 (P=0.042) were associated with postoperative atrial fibrillation. In multivariate analysis, age ≥ 60 years (P<0.001) RR 6.198 was found to be independent risk factor of AF following CABG...
European Journal of Molecular & Clinical Medicine, 2021
Background: Postoperative atrial fibrillation (POAF) is a common and potentially morbid complication following cardiac surgery. It was reported to be associated with greater inhospital mortality; prolonged hospital stays. In addition, the long-term survival was worse in patients who developed POAF. Patients who develop POAF incur additional hospital treatment cost and 2-to-4-fold increased risk of major adverse cardiac events. Objective: To determine the possible predictors of POAF after coronary artery bypass surgery and its impact on outcome. Methods: Two hundred patients were enrolled; they were divided into 2 groups; Group I (n = 100 patients) developed POAF and group II (n = 100 patients) did not developed POAF. All patients were subjected to history, examination, ECG, echocardiography, laboratory investigation as CBC, coagulation profile, kidney function tests, liver enzymes and high sensitivity troponin and coronary angiography to assess severity of coronary artery disease by SYNTAX score.
The Journal of Thoracic and Cardiovascular Surgery, 2012
The study objective was to determine the predictors of postoperative atrial fibrillation (POAF) in patients randomized to conventional coronary artery bypass graft (on-pump coronary artery bypass [ONCAB]) versus beating heart coronary surgery (off-pump coronary artery bypass [OPCAB]). Methods: The subgroup of 2103 patients (of 2203 enrollees) in the Randomized On Versus Off Bypass trial with no POAF was studied (1056 patients in the ONCAB group and 1047 patients in the OPCAB group). Univariate and multivariate analyses were used to identify the predictors of POAF and the impact of POAF on outcomes.