Different doses of metoprolol in preventing new-onset atrial fibrillation after coronary artery bypass graft: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

NIAN Fulai , QIN Wei , HE Shuai , CHEN Xin ,  WANG Liming

Department of Thoracic and Cardiovascular Surgery, Nanjing Cardiovascular Disease Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing, 210006, P.R.China;

Corresponding author：

WANG Liming, Email: xywlm@hotmail.com

Keywords：

Coronary artery bypass graft; atrial fibrillation; metoprolol

DOI：

10.7507/1007-4848.201901058

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Objective To analyze different doses of metoprolol in prevention of atrial fibrillation (AF) after coronary artery bypass graft (CABG).Methods From June 2016 to August 2017, 358 patients undergoing CABG in cardiothoracic surgery in Nanjing First Hospital were randomly divided into two groups according to the dose of metoprolol: a group A with metoprolol of 25 mg/d, a total of 182 patients, including 145 males and 37 females, with an average age of 65.40±10.52 years; a group B with metoprolol of 75 mg/d, a total of 176 patients, 138 males and 38 females with an average age of 63.31±9.04 years. The incidence of AF was observed 5 days after surgery.Results The incidence of post-CABG AF (PCAF) in the group A and the group B was 27.47%, 18.18%, respectively with a statistical difference (P=0.04). PCAF was detected its maximum peak on the second day post-surgery. Of patients at age of 70 years or more, the incidence of PCAF in the group A was higher than that in the group B with no statistical difference (P=0.18). Among the patients with left ventricular ejection fraction (LVEF) lower than 40%, there was no statistical difference in the incidence of PCAF between the two groups (P=0.76).Conclusion Metoprolol 75.00 mg/d is better than 25.00 mg/d in preventing new AF after CABG.

Citation： NIAN Fulai, QIN Wei, HE Shuai, CHEN Xin, WANG Liming. Different doses of metoprolol in preventing new-onset atrial fibrillation after coronary artery bypass graft: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(6): 553-557. doi: 10.7507/1007-4848.201901058 Copy

1.	Steinberg JS. Postoperative atrial fibrillation: a billion-dollar problem. J Am Coll Cardiol, 2004, 43(6): 1001-1003.
2.	Mathew JP, Fontes ML, Tudor IC, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA, 2004, 291(14): 1720-1729.
3.	Villareal RP, Hariharan R, Liu BC, et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol, 2004, 43(5): 742-748.
4.	Lahtinen J, Biancari F, Salmela E, et al. Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery. Ann Thorac Surg, 2004, 77(4): 1241-1244.
5.	Khan MF, Wendel CS, Movahed MR. Prevention of post-coronary artery bypass grafting (CABG) atrial fibrillation: efficacy of prophylactic beta-blockers in the modern era: a meta-analysis of latest randomized controlled trials. Ann Noninvasive Electrocardiol, 2013, 18(1): 58-68.
6.	Merritt JC, Niebauer M, Tarakji K, et al. Comparison of effectiveness of carvedilol versus metoprolol or atenolol for atrial fibrillation appearing after coronary artery bypass grafting or cardiac valve operation. Am J Cardiol, 2003, 92(6): 735-736.
7.	Chung MK, Augostini RS, Asher CR, et al. Ineffectiveness and potential proarrhythmia of atrial pacing for atrial fibrillation prevention after coronary artery bypass grafting. Ann Thorac Surg, 2000, 69(4): 1057-1063.
8.	Acikel S, Bozbas H, Gultekin B, et al. Comparison of the efficacy of metoprolol and carvedilol for preventing atrial fibrillation after coronary bypass surgery. Int J Cardiol, 2008, 126(1): 108-113.
9.	Jalalian R, Ghafari R, Ghazanfari P. Comparing the therapeutic effects of carvedilol and metoprolol on prevention of atrial fibrillation after coronary artery bypass surgery, a double-blind study. Int Cardiovasc Res J, 2014, 8(3): 111-115.
10.	Crystal E, Connolly SJ, Sleik K, et al. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis. Circulation, 2002, 106(1): 75-80.
11.	Zimmer J, Pezzullo J, Choucair W, et al. Meta-analysis of antiarrhythmic therapy in the prevention of postoperative atrial fibrillation and the effect on hospital length of stay, costs, cerebrovascular accidents, and mortality in patients undergoing cardiac surgery. Am J Cardiol, 2003, 91(9): 1137-1140.
12.	Onk OA, Erkut B. Is the Preoperative administration of amiodarone or metoprolol more effective in reducing atrial fibrillation: after coronary bypass surgery? Medicine (Baltimore), 2015, 94(41): e1576.
13.	Kamei M, Morita S, Hayashi Y, et al. Carvedilol versus Metoprolol for the prevention of atrial fibrillation after off-pump coronary bypass surgery: rationale and design of the Carvedilol or Metoprolol Post-Revascularization Atrial Fibrillation Controlled Trial (COMPACT). Cardiovasc Drugs Ther, 2006, 20(3): 219-227.
14.	Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--excutive summary. Rev Port Cardiol, 2007, 26(4): 383-446.
15.	Balcetyte-Harris N, Tamis JE, Homel P, et al. Randomized study of early intravenous esmolol versus oral beta-blockers in preventing post-CABG atrial fibrillation in high risk patients identified by signal-averaged ECG: results of a pilot study. Ann Noninvasive Electrocardiol, 2002, 7(2): 86-91.
16.	陈鑫, 徐明, 邱志兵, 等. 体外循环与非体外循环冠状动脉旁路移植术中移植血管血流量测定的对比研究. 中华胸心血管外科杂志, 2005, 21(6): 366-367.
17.	陈鑫, 郭子黄, 高岩. 连续 116 例冠状动脉搭桥无手术死亡. 中华外科杂志, 1999, 37(7): 398.
18.	Tokmakoglu H, Kandemir O, Gunaydin S, et al. Amiodarone versus digoxin and metoprolol combination for the prevention of postcoronary bypass atrial fibrillation. Eur J Cardiothorac Surg, 2002, 21(3): 401-405.
19.	Crystal E, Garfinkle MS, Connolly SS, et al. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev, 2004, (4): CD003611.
20.	Budeus M, Hennersdorf M, Perings S, et al. Amiodarone prophylaxis for atrial fibrillation of high-risk patients after coronary bypass grafting: a prospective, double-blinded, placebo-controlled, randomized study. Eur Heart J, 2006, 27(13): 1584-1591.
21.	Halonen J, Halonen P, Järvinen O, et al. Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. JAMA, 2007, 297(14): 1562-1567.
22.	Jacquet L, Evenepoel M, Marenne F, et al. Hemodynamic effects and safety of sotalol in the prevention of supraventricular arrhythmias after coronary artery bypass surgery. J Cardiothorac Vasc Anesth, 1994, 8(4): 431-436.
23.	Chin JH, Lee EH, Son HJ, et al. Preoperative treatment with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker has no beneficial effect on the development of new-onset atrial fibrillation after off-pump coronary artery bypass graft surgery. Clin Cardiol, 2012, 35(1): 37-42.
24.	Wijeysundera DN, Beattie WS, Rao V, et al. Calcium antagonists reduce cardiovascular complications after cardiac surgery: a meta-analysis. J Am Coll Cardiol, 2003, 41(9): 1496-1505.
25.	Miller S, Crystal E, Garfinkle M, et al. Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis. Heart, 2005, 91(5): 618-623.
26.	Lúcio Ede A, Flores A, Blacher C, et al. Effectiveness of metoprolol in preventing atrial fibrillation and flutter in the postoperative period of coronary artery bypass graft surgery. Arq Bras Cardiol, 2004, 82(1): 42-46.
27.	Nardi F, Diena M, Caimmi PP, et al. Relationship between left atrial volume and atrial fibrillation following coronary artery bypass grafting. J Card Surg, 2012, 27(1): 128-135.
28.	Melduni RM, Suri RM, Seward JB, et al. Diastolic dysfunction in patients undergoing cardiac surgery: a pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation. J Am Coll Cardiol, 2011, 58(9): 953-961.
29.	Thorén E, Hellgren L, Jidéus L, et al. Prediction of postoperative atrial fibrillation in a large coronary artery bypass grafting cohort. Interact Cardiovasc Thorac Surg, 2012, 14(5): 588-593.
30.	穆军升, 周帆, 张健群, 等. 冠状动脉旁路移植术后心房颤动的危险因素分析. 中国胸心血管外科临床杂志, 2009, 16(3): 179-182.

1. Steinberg JS. Postoperative atrial fibrillation: a billion-dollar problem. J Am Coll Cardiol, 2004, 43(6): 1001-1003.
2. Mathew JP, Fontes ML, Tudor IC, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA, 2004, 291(14): 1720-1729.
3. Villareal RP, Hariharan R, Liu BC, et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol, 2004, 43(5): 742-748.
4. Lahtinen J, Biancari F, Salmela E, et al. Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery. Ann Thorac Surg, 2004, 77(4): 1241-1244.
5. Khan MF, Wendel CS, Movahed MR. Prevention of post-coronary artery bypass grafting (CABG) atrial fibrillation: efficacy of prophylactic beta-blockers in the modern era: a meta-analysis of latest randomized controlled trials. Ann Noninvasive Electrocardiol, 2013, 18(1): 58-68.
6. Merritt JC, Niebauer M, Tarakji K, et al. Comparison of effectiveness of carvedilol versus metoprolol or atenolol for atrial fibrillation appearing after coronary artery bypass grafting or cardiac valve operation. Am J Cardiol, 2003, 92(6): 735-736.
7. Chung MK, Augostini RS, Asher CR, et al. Ineffectiveness and potential proarrhythmia of atrial pacing for atrial fibrillation prevention after coronary artery bypass grafting. Ann Thorac Surg, 2000, 69(4): 1057-1063.
8. Acikel S, Bozbas H, Gultekin B, et al. Comparison of the efficacy of metoprolol and carvedilol for preventing atrial fibrillation after coronary bypass surgery. Int J Cardiol, 2008, 126(1): 108-113.
9. Jalalian R, Ghafari R, Ghazanfari P. Comparing the therapeutic effects of carvedilol and metoprolol on prevention of atrial fibrillation after coronary artery bypass surgery, a double-blind study. Int Cardiovasc Res J, 2014, 8(3): 111-115.
10. Crystal E, Connolly SJ, Sleik K, et al. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis. Circulation, 2002, 106(1): 75-80.
11. Zimmer J, Pezzullo J, Choucair W, et al. Meta-analysis of antiarrhythmic therapy in the prevention of postoperative atrial fibrillation and the effect on hospital length of stay, costs, cerebrovascular accidents, and mortality in patients undergoing cardiac surgery. Am J Cardiol, 2003, 91(9): 1137-1140.
12. Onk OA, Erkut B. Is the Preoperative administration of amiodarone or metoprolol more effective in reducing atrial fibrillation: after coronary bypass surgery? Medicine (Baltimore), 2015, 94(41): e1576.
13. Kamei M, Morita S, Hayashi Y, et al. Carvedilol versus Metoprolol for the prevention of atrial fibrillation after off-pump coronary bypass surgery: rationale and design of the Carvedilol or Metoprolol Post-Revascularization Atrial Fibrillation Controlled Trial (COMPACT). Cardiovasc Drugs Ther, 2006, 20(3): 219-227.
14. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--excutive summary. Rev Port Cardiol, 2007, 26(4): 383-446.
15. Balcetyte-Harris N, Tamis JE, Homel P, et al. Randomized study of early intravenous esmolol versus oral beta-blockers in preventing post-CABG atrial fibrillation in high risk patients identified by signal-averaged ECG: results of a pilot study. Ann Noninvasive Electrocardiol, 2002, 7(2): 86-91.
16. 陈鑫, 徐明, 邱志兵, 等. 体外循环与非体外循环冠状动脉旁路移植术中移植血管血流量测定的对比研究. 中华胸心血管外科杂志, 2005, 21(6): 366-367.
17. 陈鑫, 郭子黄, 高岩. 连续 116 例冠状动脉搭桥无手术死亡. 中华外科杂志, 1999, 37(7): 398.
18. Tokmakoglu H, Kandemir O, Gunaydin S, et al. Amiodarone versus digoxin and metoprolol combination for the prevention of postcoronary bypass atrial fibrillation. Eur J Cardiothorac Surg, 2002, 21(3): 401-405.
19. Crystal E, Garfinkle MS, Connolly SS, et al. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev, 2004, (4): CD003611.
20. Budeus M, Hennersdorf M, Perings S, et al. Amiodarone prophylaxis for atrial fibrillation of high-risk patients after coronary bypass grafting: a prospective, double-blinded, placebo-controlled, randomized study. Eur Heart J, 2006, 27(13): 1584-1591.
21. Halonen J, Halonen P, Järvinen O, et al. Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. JAMA, 2007, 297(14): 1562-1567.
22. Jacquet L, Evenepoel M, Marenne F, et al. Hemodynamic effects and safety of sotalol in the prevention of supraventricular arrhythmias after coronary artery bypass surgery. J Cardiothorac Vasc Anesth, 1994, 8(4): 431-436.
23. Chin JH, Lee EH, Son HJ, et al. Preoperative treatment with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker has no beneficial effect on the development of new-onset atrial fibrillation after off-pump coronary artery bypass graft surgery. Clin Cardiol, 2012, 35(1): 37-42.
24. Wijeysundera DN, Beattie WS, Rao V, et al. Calcium antagonists reduce cardiovascular complications after cardiac surgery: a meta-analysis. J Am Coll Cardiol, 2003, 41(9): 1496-1505.
25. Miller S, Crystal E, Garfinkle M, et al. Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis. Heart, 2005, 91(5): 618-623.
26. Lúcio Ede A, Flores A, Blacher C, et al. Effectiveness of metoprolol in preventing atrial fibrillation and flutter in the postoperative period of coronary artery bypass graft surgery. Arq Bras Cardiol, 2004, 82(1): 42-46.
27. Nardi F, Diena M, Caimmi PP, et al. Relationship between left atrial volume and atrial fibrillation following coronary artery bypass grafting. J Card Surg, 2012, 27(1): 128-135.
28. Melduni RM, Suri RM, Seward JB, et al. Diastolic dysfunction in patients undergoing cardiac surgery: a pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation. J Am Coll Cardiol, 2011, 58(9): 953-961.
29. Thorén E, Hellgren L, Jidéus L, et al. Prediction of postoperative atrial fibrillation in a large coronary artery bypass grafting cohort. Interact Cardiovasc Thorac Surg, 2012, 14(5): 588-593.
30. 穆军升, 周帆, 张健群, 等. 冠状动脉旁路移植术后心房颤动的危险因素分析. 中国胸心血管外科临床杂志, 2009, 16(3): 179-182.

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Different doses of metoprolol in preventing new-onset atrial fibrillation after coronary artery bypass graft: A randomized controlled trial

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