Preoperative use of sotalol versus atenolol for atrial fibrillation after cardiac surgery.

BACKGROUND

Atrial fibrillation is one of the most common complications of cardiac surgery. Beta blockers have been demonstrated to decrease the incidence of postoperative atrial fibrillation. Preliminary investigations reporting sotalol and atenolol to be effective in preventing postoperative atrial fibrillation are encouraging, but no studies have been conducted comparing both drugs.

METHODS

A total of 253 consecutive eligible patients (66 +/- 8 years; mean +/- standard deviation) scheduled to undergo cardiac surgery were enrolled in this study. Patients were randomized in a prospective open manner 1.5:1 to atenolol group (50 mg/daily; 153 patients) or sotalol group (80 mg twice daily; 100 patients).

RESULTS

Atrial fibrillation occurred in 44/253 patients (17.45%). A significant difference was found in the occurrence of atrial fibrillation in the atenolol group (34 patients, 22%) compared with those receiving sotalol (10 patients, 10%; p = 0.013). Therapeutic efficiency and efficacy was 12% and 54%, respectively. Stepwise logistic regression analysis revealed that age more than 68 years old (odds ratio = 2.72; 95% confidence interval [CI] = 1.37-5.41; p = 0.004), the use of beta-adrenergic agents (odds ratio = 2.74; 95% CI = 1.5-5; p = 0.001), and sotalol (odds ratio = 0.46; 95% CI = 0.23-0.95; p = 0.035) were independently associated with development of atrial fibrillation.

CONCLUSIONS

Oral low-dose sotalol provides a considerable reduction in the occurrence of atrial fibrillation. A selective approach based on clinical risk prediction should decrease the occurrence of atrial fibrillation after cardiac surgery.