Carvedilol Is More Effective Than Metoprolol In Preventing The Atrial Fibrillation Seen After Coronary Artery Bypass Surgery

Abstract

Atrial fibrillation (AF) which is a common complication seen after open heart surgery may be a cause of postoperative heart failure and embolic events as well as it increases the hospitalization costs due to increased hospitalization duration. AF incidence is decreased by prophylactic beta blocker medication. In this study we retrospectively evaluated the prophylactic carvedilol and metoprolol medications in prevention of AF after coronary bypass surgery. Materials and methods: The preoperative, perioperative and postoperative data of 146 patients who were operated for isolated coronary artery disease and who were under beta-blocker treatment were evaluated. Preoperatively 76 patients were under carvedilol medication whereas 70 patients were under metoprolol medication. Beta-blocker treatment was continued before and after the operation. Patients who had AF after the operation (group 1, n=27) and who don't have AF (group 2, n=119) were evaluated as separate groups. Results: Univariate analysis showed that advanced age, left atrial dimensions, carvedilol medication and statin medication were related with postoperative AF. On the other hand multivariate analysis revealed that advanced age and left atrial dimensions were independent risk factors for postoperative AF occurrence whereas carvedilol medication was found to be an independent factor for prevention of AF. Postoperative hospitalization was significantly increased in patients with AF. Conclusion: The incidence of postoperative AF is decreased by prophylactic beta-blocker medication. Carvedilol has a more prominent effect on prevention of AF when compared with metoprolol.

Keywords

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Koroner Arter Baypas Cerrahisi Sonras›nda Görülen Atriyal Fibrilasyonun Önlenmesinde Karvedilol Metoprololden Daha Etkilidir

Abstract

Aç›k kalp cerrahisinden sonar yayg›n olaarak görülen bir komplikasyon olan Atriyal fibrilasyon (AF), postoperative dönemde kalp yetmezli¤ine, embolik olaylara neden olabilir ve hastanede kal›fl süresini de uzatarak hastane maliyetlerini art›rabilir. Beta blokör tedavi uygulanmas› ile bu hastalarda AF görülme s›kl›¤› azalt›labilmektedir. Bu araflt›rmada koroner arter baypas cerrahisi sonras›nda AF geliflmesini önlmede karvedilol ve metoprolol kullan›m›n› karfl›laflt›rd›k. Gereç Yöntem: ‹zolekoroner arter baypas cerrahisi uygulanan, betabloker tedavisi alan 146 hastan›n operasyon öncesinde, operasyon esnas›nda ve sonras›nda kay›t edilen verileri de¤erlendirildi. Ameliyata al›nmadan önceki dönemde 76 hasta karvedilol, 70 hasta metoprolol kullanmaktayd›. Beta blokör tedavisine ameliyat sabah›na kadar devam adilerek ameliyattan sonar tekrar baflland›. Ameliyat sonras› AF ritmi görülen (grup 1, n=27) ve görülmeyen hastalar (grup 2, n=117) iki ayr› grup olarak de¤erlendirildi.Bulgular: ‹leri yafl, sol atriyum çap›, karvedilol tedavisi, statin tedavisi univaryans analiz ile de¤erlendirme sonucunda postoperative AF ritminin gelifliminde rol oynayan faktörler olarak tespit edildi. Multivaryans analiz ile bu faktörler de¤erlendirildi¤inde ise ileri yafl ve sol atriyum çaplar› AF gelifliminde ba¤›ms›z risk faktörleri olarak tespit edilirken, karvedilol kullan›m› AF geliflimi üzerine önleyici etkisi olan ba¤›ms›z bir faktör olarak belirlendi. Postoperatif dönemde hastanede kal›fl süresi AF ritmi görülen hastalarda belirgin olrak uzundu. Sonuç: Atriyal fibrilasyon ritminin görülme s›kl›¤› profilaktik betablokör kullan›m› ile azalt›lmaktad›r. Karvedilol, koroner arter baypas cerrahisi sonras›nda AF ritmi geliflmesini metoprolole göre belirgin oranda azaltmaktad›r.

Keywords

• Mustafa Saçar .tool_j {font-family: Helvetica, Arial;font-size: 8pt;color:#575747;line-height: 160%;} A.tool_j:link {font-family: Helvetica, Arial;font-size: 8pt;color:#575747;text-decoration: none;} A.tool_j:visited {font-family: Helvetica

References

1. Mahoney EM, Thompson TD, Veledar E, Williams J, Weintraub WC. Cost-effectiveness of targeting patients undergoing cardiac surgery for therapy with inrtaveno- us amiodarone to prevent atrial fibrillation. J Am Coll Cardiol 2002;40:737-745
2. Hakala T, Pitkanen O, Hippelainen M. Feasibility of pre- dicting the risk of atrial fibrillation after coronary artery bypass surgery with logistic regression model. Scand J Surg 2002;91:339-344.
3. Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, Barash PG, Hsu PH, Mangano DT; Investiga- tors of the ishemia research and education foundation; Multicenter study of perioperative ischemia research group. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004 ;291:1720-1729.
4. Svedjeholm R, Hakanson E. Predictors of atrial fibrilla- tion in patients undergonin surgery for ischemic heart disease. Scand Cardiovasc J 200;34:516-521.
5. Fuller JA, Adams GG, Buxton B. Atrial fibrillation after coronary artery bypass grafting. J Thorac Cardiovasc Surg 1989;97:821-825.
6. Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elay- da M, Lopez JA, Rasekh A, Wilson JM, Massumi A. Pos- toperative atrial fibrillation and mortality and mortality af- ter coronary artery bypass surgery. J Am Coll Cardiol 2004;43:742-748.
7. Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, Collins JJ Jr, Cohn LH, Burstin HR. Pre- dictors of atrial fibrillation after coronary artery surgery: current trends and impact on hospital resources. Circula- tion 1996;94:390-397.
8. Crystal E, Connolly SJ, Sleik K, Ginger TJ, Yusuf S. Interventions on prevention of potsoperative atrial fibrilla- tion in patients undergoing heart surgery: a meta-analysis. Circulation 2002;106:75-80.

9. Goette A. Pacing to prevent atrial fibrillation after
10. coronary artery sbypass grafting. What works, what
11. doesn’t: insights from Bachmann’s Bundle pacing. Card Electrophysiol Rev 2003;7:154-157.
12. Conti VR, Ware DL. Cardiac arrhythmias in cardiotho- racic surgery. Chest Surg Clin N Am 2002;12:439-460.
13. Maisel EH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med 2001;135:1061-1073. 1122.. Saltman AE. Is it time to choose amiodarone for pos- toperative atrial fibrillation? J Thorac Cardiovasc Surg 2003;125:1202-1203.
14. Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, Hart JC, Herrmann HC, Hillis LD, Hutter AM Jr, Lytle BW, Marlow RA, Nugent WC, Orszulak TA; American College of Cardiology; American Heart
15. Acikel S, Bozbas H, Gultekin B, Aydinalp A, Saritas B, Bal U, Yildirir A, Muderrisoglu H, Sezgin A, Ozin B. Com- parison of the efficacy of metoprolol and carvedilol for preventing atrial fibrillation after coronary bypass sur- gery. Int J Cardiol (2007), doi:10.1016/j.icard.2007.03.123. 1166.. Merritt JC, Niebauer M, Tarakji K, Hammer D, Mills RM.Comparison of effectiveness of carvedilol versus me- toprolol or atenolol for atrial fibrillation appearing after coronary artery bypass grafting or cardiac valve operation. Am J Cardiol 2003;92:735–736.
16. Banach M, Okonski P, Zaslonka J. Atrial fibrillation following cardiosurgical operations – current guidelines of pharmacotherapy and invasive treatment. Pol J Surg 2005;77:398-412.
17. Auer J, Weber T, Berent R, Ng CK, Lamm G, Eber B. Risk factors of postoperative atrial fibrillation after cardiac surgery. J Cardiac Surg 2005;20:425-431.
18. Ommen SR, Odell JA, Stanton MS. Atrial arrhythmias after cardiothoracic surgery. N Eng J Med 1997;336:1429-1434.
19. Chung MK, Martin DO, Sprecher D, Wazni O, Kande- rian A, Carnes CA, Bauer JA, Tchou PJ, Niebauer MJ, Na- tale A, Van Wagoner DR. C-reactive protein elevation in patients with atrial arrhythmias: Inflammatory mechanism and persistence of atrial fibrillation. Circulation 2001;104:2886-2891.
20. Bruins P, te Velthuis H, Yazdanbakhsh AP, Jansen PG, van Hardevelt FW, de Beaumont EM, Wildevuur CR, Eijs- man L, Trouwborst A, Hack CE. Activation of the comple- ment system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-ractive protein and is associated with postoperative arrhythmia. Circula- tion 1997;96:3542-3548.
21. Carnes CA, Chung MK, Nakayama T, Nakayama H, Baliga RS, Piao S, Kanderian A, Pavia S, Hamlin RL, McCarthy PM, Bauer JA, Van Wagoner DR. Ascorbate attenuates atrial pacing-induced peroxynitrite formation and electrical remodeling and decreases the incidence of postoperative atrial fibrillation. Circ Res 2001;89:32-38. 2233.. Marin F, Pascual DA, Roldan V, Arribas JA, Ahuma- da M, Tornel PL, Oliver C, Gomez-Plana J, Lip GYH, Val- des M. Statins and postoperative risk of atrial fibrillation following coronary artery bypass grafting. Am J Cardiol 2006;97:55-60.
22. Ekim H, Kutay V, Hazar A, Akbayrak H, Ba?el H, Tun- cer M. Effects of posterior pericardiotomy on the incidence of pericardial effusion and atrial fibrillation after coronary revascularization. Med Sci Monit 2006;12:431-434.
23. Arbatli H, Demirsoy E, Aytekin S, Rizaoglu E, Unal M, Yagan N, Sonmez B. The role of posterior pericardiotomy on the incidence of atrial fibrillation after coronary revas- cularization. J Cardiovasc Surg 2003; 44:713-717.
24. Banach M, Rysz J, Drozdz J, Okonski P, Misztal M, Barylski M, Irzmanski R, Zaslonka J. Risk factors of atrial fibrillation following coronary artey bypass grafting. Circ J. 2006;70:438-441.
25. Enc Y, Ketenci B, Ozsoy D, Camur G, Kayacioglu I, Terzi S, Cicek S. Atrial fibrillation after surgical revascula- rization: Is there any difference between of-pump and off-pump? Eur J Cardiothorac Surg 2004;26:1129-1133. 2288.. Komatsu T, Nakamura S, SuzukiO, Horiuchi D, Yomo- gida K, Okumura K. Long-term prognosis of patients with paroxysmal atrial fibrillation depends on their response to antiarrhythmic therapy. Circ J 2004;68:729-733.
26. Stroe AF, Gheorghiade M. Cavedilol: beta-blockade and beyond. Rev Cardiovasc Med 2004;5:18-27.
27. McBride BF, White CM. Critical differences among be- ta-adrenoreceptor antagonists in myocardial failure: deba- ting the MERIT or COMET. J Clin Pharmacol 2005;45:6-24. 3311.. Daoud EG, Strickberger SA, Man KC, Goyal R, Deeb GM, Bolling SF, Pagani FD, Bitar C, Meissner MD, Mo- rady F. Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Eng J Med 1997;337:1785-1791.
28. Arumanayagam M, Chan S, Tong S, Sanderson JE. Antioxidant properties of carvedilol and metoprolol in
29. heart failure: a double-blind randomized controlled trial. J Cardiovasc Pharmacol 2001;37:48-54.
30. Ridker PM, Rifai N, Lowenthal SP. Rapid reduction in C-reactive protein with cerivastatin among 785 patients with primary hypercholesterolemia. Circulation. 2001;103:1191-1193.
31. Kumagai K, Nakashima H, Saku K. The HMG-CoA reductase inhibitor atorvastatin prevents atrial fibrillation by inhibiting inflammation in a canine sterile pericarditis model. Cardiovasc Res 2004;62:105-111.
32. Creswell LL, Alexander JC, Ferguson TB, Lisbon A, Fleisher LA. Intraoperative Interventions. American college of chest physicians guidelines fort the prevention and management of postoperative atrial fibrillation after
33. cardiac surgery. Chest 2005;128:28-35.
34. Kitzman DW, Edwards WD. Age-related changes in the anatomy of the normal human heart. J Gerontol 1990;45:33-39.
35. Jayam VK, Flaker GC, Jones JW. Atrial fibrillation after coronary bypass:Etiology and pharmacologic prevention. Cardiovsc Surg 2002;10:351-358.
36. Tamis JE, Kowalski M, Rill V, Firoozi K, Steinberg JS. Patterns of atrial fibrillation after coronary bypass surgery. ANE 2006;11:139-144.