Perioperative use of a beta blocker in coronary artery bypass grafting

Abstract

Objectives: Atrial fibrillation after cardiac surgery is associated with increases in the risk of complications, length of intensive care unit stay, and cost of care. Beta blockers are effective for controlling myocardial ischemia and arrhythmia and suppressing inflammatory cytokines. The purpose of this study was to examine the effect of administrating a short-acting beta-adrenoceptor antagonist, landiolol, on postoperative atrial fibrillation.

Methods: 136 patients undergoing off-pump coronary artery bypass grafting were single-blindly assigned randomly to landiolol (n = 68) and non-landiolol (control, n = 68) groups. In the landiolol group, the beta blocker was administered from the beginning of the operation until postoperative day 2. The primary endpoint was the incidence of atrial fibrillation until postoperative day 7, and the secondary endpoints were the postoperative levels of troponin I, creatine kinase MB-isoenzyme, and C-reactive protein.

Results: The incidence of atrial fibrillation was significantly lower in the landiolol group compared to the control group (13/68, 19% vs. 25/68, 37%, p = 0.02, logrank test). Landiolol also significantly reduced the postoperative peak C-reactive protein level compared to the control group (132 ± 55.4 vs. 161 ± 50.9 mgċL(-1), p = 0.004).

Conclusion: Low-dose continuous infusion of landiolol reduced the incidence of postoperative atrial fibrillation, and significantly suppressed inflammation.

Keywords: Landiolol [supplementary concept]; adrenergic beta-antagonists; atrial fibrillation; coronary artery bypass; perioperative care.