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Ann Thorac Surg 1999;67:182-186
© 1999 The Society of Thoracic Surgeons
a Department of Pharmacy Services, London Health Sciences Centre, London, Ontario, Canada
b Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
c Medicine, London Health Sciences Centre, London, Ontario, Canada
Address reprint requests to Dr Inculet, London Health Sciences Centre, 375 South St, London, Ontario, N6A 4G5, Canada
Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.
Background. Prevention of postoperative arrhythmias in patients undergoing general thoracic surgery is desirable to prevent morbidity.
Methods. A randomized, double-blind, placebo controlled trial of propranolol (10 mg every 6 hours) for 5 days was undertaken in patients undergoing major thoracic operations to determine whether arrhythmias requiring treatment could be reduced. Secondary outcomes included overall arrhythmia rate, adverse events, and length of stay. Arrhythmias were assessed by 72-hour Holter monitoring. Patients with a history of heart failure, asthma, advanced heart block, preexisting arrhythmias, sensitivity to propranolol, or use of antiarrhythmic drugs were excluded.
Results. Using the intention-to-treat principle there was a 70% relative risk reduction from 20% to 6% in the rate of treated arrhythmias with propranolol (p = 0.071, 95% confidence interval 0.6% to 27.2%). Overall arrhythmias were common but usually benign. Adverse effects were common, although generally mild with hypotension and bradycardia being reported more often in the propranolol group. Length of stay was not different.
Conclusions. There was a trend to a reduction in the risk of perioperative arrhythmias with propranolol. Moreover, propranolol was well tolerated showing a slight increase in minor adverse events.
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