Cardona Francisco, Seide Hanscy, Cox Rafael A, Pérez Cynthia M
Department of Medicine, School of Medicine, University of Puerto Rico.
P R Health Sci J. 2003 Jun;22(2):119-23.
This pilot study aimed to compare right atrial pacing, intravenous amiodarone and oral beta-blockers in the prevention, time to onset, duration and effect on hospital stay of postoperative atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) at our center.
AF is the most common arrhythmic complication after CABG and is related to increased morbidity, length of hospital stay and costs. Trials with different drugs and other therapeutic modalities including beta-blockers, intravenous amiodarone and override suppression of automatic atrial foci by atrial pacing have shown partial success as preventive measures. However, a comparison between those three interventions has not been reported.
Thirty-six consecutive patients that underwent CABG at our institution were randomly assigned to atrial pacing (18 patients) and intravenous amiodarone (18 patients) after baseline clinical, electrocardiographic and hemodynamic assessment. All patients received concomitant oral metoprolol or atenolol right after extubation. Thirty-three patients who had CABG at our center in the previous two months and that only received beta-blockers during their perioperative period served as a control group.
The majority of baseline clinical and hemodynamic characteristics were similar in all groups. Only one patient (5.6%) developed AF in the atrial pacing group versus five (27.8%) on amiodarone and six (18.2%) who only received beta-blockers. That finding, however, did not attain statistical significance (p > 0.05). After adjusting for potential confounders, the odds of occurrence of AF was 77% lower in atrial pacing patients (OR = 0.23; 95% CI: 0.02, 2.20; p = 0.09) and 2.36 times higher in those on amiodarone (95% CI: 0.55, 10.24; P = 0.053) when compared to patients which only received beta blockers. Since only one patient on right atrial pacing developed atrial fibrillation, the analysis of the median time to onset and median duration of atrial fibrillation was restricted to those assigned to amiodarone and those who only received beta-blockers showing no statistically significant differences (p > 0.05). Although no statistical significance was achieved, the median hospital stay was one-day shorter in the beta-blockers group. Most of the side effects were minor and resolved without sequelae.
This pilot study showed a trend in favor of atrial pacing versus intravenous amiodarone or beta-blockers in the prevention of postoperative AF after CABG in our center. Randomization of a larger patient sample would be required in order to ascertain the true value of the observed trend.
本初步研究旨在比较右心房起搏、静脉注射胺碘酮和口服β受体阻滞剂在我院冠状动脉旁路移植术（CABG）后预防术后心房颤动（AF）、发作时间、持续时间及对住院时间的影响。
AF是CABG后最常见的心律失常并发症，与发病率增加、住院时间延长及费用增加有关。使用不同药物及其他治疗方式（包括β受体阻滞剂、静脉注射胺碘酮以及通过心房起搏抑制心房自动节律点）的试验已显示出作为预防措施的部分成功。然而，尚未有这三种干预措施之间比较的报道。
在我们机构接受CABG的36例连续患者，在进行基线临床、心电图和血流动力学评估后，随机分为心房起搏组（18例患者）和静脉注射胺碘酮组（18例患者）。所有患者在拔管后立即同时接受口服美托洛尔或阿替洛尔治疗。在前两个月在我院接受CABG且仅在围手术期接受β受体阻滞剂治疗的33例患者作为对照组。
所有组的大多数基线临床和血流动力学特征相似。心房起搏组仅1例患者（5.6%）发生AF，而胺碘酮组为5例（27.8%），仅接受β受体阻滞剂治疗的患者为6例（18.2%）。然而，该结果未达到统计学显著性（p>0.05）。在对潜在混杂因素进行校正后，与仅接受β受体阻滞剂治疗的患者相比，心房起搏患者发生AF的几率降低77%（OR=0.23；95%CI：0.02，2.20；p=0.09），而胺碘酮组患者发生AF的几率高2.36倍（95%CI：0.55，10.24；P=0.053）。由于右心房起搏组仅有1例患者发生心房颤动，因此对心房颤动发作的中位时间和中位持续时间的分析仅限于胺碘酮组和仅接受β受体阻滞剂治疗的患者，结果显示无统计学显著差异（p>0.05）。虽然未达到统计学显著性，但β受体阻滞剂组的中位住院时间短1天。大多数副作用轻微，且未留下后遗症。
本初步研究显示，在我院CABG后预防术后AF方面，心房起搏相对于静脉注射胺碘酮或β受体阻滞剂有一定趋势。需要对更大样本的患者进行随机分组，以确定观察到的趋势的真正价值。
