Efficacy of nadolol in preventing supraventricular tachycardia after coronary artery bypass grafting

Abstract

To investigate the efficacy of nadolol in the prevention of supraventricular arrhythmias after coronary artery bypass graft (CABG) surgery, 148 patients undergoing elective CABG were randomized in double-blind, placebo-controlled fashion to receive either nadolol or placebo. The test medication was started on the first postoperative morning and maintained as a single daily dose for 6 weeks. Aside from routine daily clinical evaluation and postoperative electrocardiographic monitoring, patients underwent 24-hour Holter recording once preoperatively and 3 times postoperatively. Seven patients were excluded from the evaluation of efficacy analysis because of insufficient postoperative data. There were no significant differences between the patients receiving nadolol (n = 67) and those receiving placebo (n = 74) with respect to age, preoperative heart rate, previous medications (including beta blockers), incidence of previous myocardial infarction, frequency of preoperative ventricular and supraventricular arrhythmias, concomitant valvular heart disease, mean cardiopulmonary bypass time, mean aortic cross-clamp time, use of blood and crystalloid cardioplegia, mean number of bypass grafts placed, postoperative use of inotropic agents and catecholamines and incidence of perioperative myocardial infarction. Analysis of postoperative Holter recordings showed that the heart rate was consistently and significantly higher in the placebo group throughout the period of the study (p less than 0.001). The average number of premature atrial contractions was significantly smaller in the nadolol group (p less than 0.05), and nadolol patients had fewer ventricular premature complexes, couplets and non-sustained ventricular tachycardias during the first week postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)