Abstract
ObjectiveTo investigate the efficacy of prophylactic administration of low-dose landiolol on postoperative atrial fibrillation (POAF) in patients after cardiovascular surgery.MethodsConsecutive 150 patients over 70 years of age who underwent cardiovascular surgery for valvular, ischemic heart, and aortic diseases were enrolled in this single-center prospective randomized control study from 2010 to 2014. They were assigned to three treatment groups: 1γ group (landiolol at 1 μg/kg/min), 2γ group (landiolol at 2 μg/kg/min), or control group (no landiolol). In the two landiolol groups, landiolol hydrochloride was intravenously administered for a period of 4 days postoperatively. Electrocardiography was continuously monitored during the study period, and cardiologists eventually assessed whether POAF occurred or not.ResultsPOAF occurred in 24.4% of patients in the control group, 18.2% in 1γ group, and 11.1% in 2γ group (p = 0.256). Multivariate logistic regression analysis showed that the incidence of POAF tended to decrease depending on the dose of landiolol (trend-p = 0.120; 1γ group: OR = 0.786, 95% CI 0.257–2.404; 2γ group: OR = 0.379, 95% CI 0.112–1.287). Subgroup analysis showed a significant dose-dependent reduction in POAF among categories of female sex, non-use of angiotensin II receptor blockers (ARBs) before surgery, and valve surgery (each trend-p = 0.02, 0.03, and 0.004).ConclusionsThese findings indicate that prophylactic administration of low-dose landiolol may not be effective for preventing the occurrence of POAF in overall patients after cardiovascular surgery, but the administration could be beneficial to female patients, patients not using ARBs preoperatively, and those after valvular surgery.
Highlights
Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiovascular surgery
Guidelines published by the American College of Cardiology/American Heart Association/European Society of Cardiology and the American Association for Thoracic Surgery recommend against withdrawal of preoperative oral β-blockers medication and for their continuous usage during the perioperative period to reduce the incidence of POAF in patients undergoing cardiac surgery [7, 8]
After 150 patients were allocated randomly into the control, 1γ, and 2γ groups, 16 patients were withdrawn from this study due to the following reasons: side effects such as hypotension (3 patients in the 1γ group and 2 in the 2γ group) and bradycardia (1 thoracic endovascular aortic repair (TEVAR) patient in the 2γ group without having a temporary epicardial pacemaker wire), immediate re-operation (1 patient in the control group and 2 in the 2γ group), difficulty in administering landiolol due to hypotension (2 patient in the 1γ group), deviation from the protocol (4 patients in the control group receiving variable doses of landiolol for tachycardia), and a physician’s judgement (1 patient in the 1γ group)
Summary
Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiovascular surgery. General Thoracic and Cardiovascular Surgery (2020) 68:1240–1251 in-hospital and long-term mortality [5]. Another meta-analysis found that preoperative use of β-blockers reduced the occurrence of new onset atrial fibrillation [6]. Guidelines published by the American College of Cardiology/American Heart Association/European Society of Cardiology and the American Association for Thoracic Surgery recommend against withdrawal of preoperative oral β-blockers medication and for their continuous usage during the perioperative period to reduce the incidence of POAF in patients undergoing cardiac surgery (recommendation class I, level of evidence A) [7, 8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
