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The Journal of Thoracic and Cardiovascular Surgery, Vol 94, 331-335, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
DA Rubin, KE Nieminski, GE Reed and MV Herman
Multiple trials have suggested the use of digoxin, digoxin and propranolol,
or timolol to prevent atrial fibrillation after coronary artery bypass
grafting. No trial has evaluated the efficacy of digoxin verus propranolol.
Furthermore, the predictors of postoperative atrial fibrillation and the
long-term consequence of atrial fibrillation that reverts to sinus rhythm
have not been established. One hundred fifty patients were randomized to
receive no drug, propranolol (20 mg every 6 hours), or digoxin (0.5 mg
followed by 0.25 mg daily). Twenty-seven patients were excluded from data
analysis. In the remaining 123 patients, no preoperative parameter (age,
sex, diabetes, hypertension, smoking, electrocardiographic p wave
morphology, or preoperative digoxin or propranolol therapy), intraoperative
parameter (bypass time, aortic cross-clamp time, or number of vessels
bypassed), or postoperative parameter (peak creatinine kinase, congestive
heart failure, or pericarditis) by univariate or multivariate analysis
predicted patients at risk for atrial fibrillation. Sustained atrial
fibrillation developed in 37.5% of control and 32.6% of digoxin-treated
patients. Only 16.2% of propranolol-treated patients had sustained atrial
fibrillation (p less than 0.03). There were no in-hospital complications in
those patients with atrial fibrillation. After 26 +/- 7 months follow-up,
those patients with postoperative atrial fibrillation had no increased
incidence of angina, cerebral vascular accident, myocardial infarction, or
sudden death. Therefore, in this select population, propranolol prophylaxis
is effective but discretionary.
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Predictors, prevention, and long-term prognosis of atrial fibrillation after coronary artery bypass graft operations
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