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Ann Thorac Surg 2007;84:61-66
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

ß-Blocker Prophylaxis for Atrial Fibrillation After Coronary Artery Bypass Grafting in Patients With Sympathovagal Imbalance

^a Department of Cardiology, West-German Heart Centre, University of Duisburg-Essen, Essen, Germany
^b Department of Thorax- and Cardiovascular Surgery, Surgical Clinic and Policlinic B, Heinrich-Heine-University, Duesseldorf, Germany
^c Department of Cardiology and Angiology, University Hospital Herne, Ruhr-University Bochum, Herne, Germany

Accepted for publication February 6, 2007.

^_* Address correspondence to Dr Budeus, Department of Cardiology, West-German Heart Centre, University of Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany (Email: marco.budeus{at}medizin.uni-essen.de).

Background: Atrial fibrillation (AF) is the most common arrhythmia after coronary bypass grafting (CABG) resulting in a prolonged hospital stay and higher costs. The withdrawal of ß-blocker and a sympathovagal imbalance were identified as risk factors for AF.

Methods: In our study we performed a measuring of standard deviation of all normal RR intervals (SDNN) among 142 consecutive patients with ß-blocker therapy before CABG in order to identify a collective who had an increased risk due to a withdrawal of ß-blocker medication. A sympathovagal imbalance was predefined as a SDNN below 30 ms. Patients were divided into four groups according to the results of SDNN and the continuous ß-blocker therapy: group I: SDNN 30 ms or less and withdrawal of ß-blocker therapy (26 patients); group II: SDNN 30 ms and continuously ß-blocker therapy (33 patients); group III: SDNN > 30 ms and withdrawal of ß-blocker therapy (40 patients); group IV: SDNN > 30 ms and continuous ß-blocker therapy (43 patients).

Results: Atrial fibrillation occurred in 39 patients (27%) after surgery. Patients of group I showed a higher incidence of AF (14 of 26 patients, 54%) than patients of group II (7 of 33 patients, 21%; p < 0.009), patients of group III (8 of 40 patients, 20%; p < 0.004), or patients of group IV (10 of 43 patients, 23%; p < 0.01). We found a significantly higher incidence of diabetes mellitus (47 vs 14% of patients; p < 0.0001) in patients with a sympathovagal imbalance than patients with a SDNN above 30 ms.

Conclusions: The results of our study suggest a sympathovagal imbalance and withdrawal of a ß-blocker therapy increase the risk of postoperative AF. A continuous ß-blocker therapy reduces the risk especially in patients with a sympathovagal imbalance and should always be practiced.

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Invited commentary

Calin Vicol
Ann. Thorac. Surg. 2007 84: 66. [Extract] [Full Text] [PDF]

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				C. Vicol Invited commentary Ann. Thorac. Surg., July 1, 2007; 84(1): 66 - 66. [Full Text] [PDF]