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

Öz

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.

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

Öz

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.

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