Acikel Sadik, Bozbas Huseyin, Gultekin Bahadir, Aydinalp Alp, Saritas Bulent, Bal Ugur, Yildirir Aylin, Muderrisoglu Haldun, Sezgin Atilla, Ozin Bulent
Baskent University Faculty of Medicine, Department of Cardiology, Ankara, Turkey.
Int J Cardiol. 2008 May 7;126(1):108-13. doi: 10.1016/j.ijcard.2007.03.123. Epub 2007 May 17.
Atrial fibrillation (AF) occurs frequently after coronary artery bypass grafting (CABG) and often results in prolonged postsurgical hospital stays and increased mortality and morbidity. Beta blockers are known to prevent postoperative AF. In this prospective study, we investigated the efficacy of carvedilol compared with metoprolol succinate in preventing postoperative AF.
Subjects included 110 patients (31 women, 79 men; mean age, 60+/-10 years, range, 39-82 years) who had undergone CABG. Patients were randomized to receive either metoprolol or carvedilol, and all patients received the drugs 3 days prior to surgery. Metoprolol was started at 50 mg twice daily and carvedilol was started at 12.5 mg twice daily. The doses were titrated according to the patients' hemodynamic responses. All patients were monitored for 3 days after the surgery.
Of the 110 patients, 55 (50%) were treated with metoprolol succinate, and 55 (50%) were treated with carvedilol. Baseline characteristics and operative data of the patients did not differ between groups. During follow-up, 20 patients (36%) in the metoprolol group and 9 patients (16%) in the carvedilol group developed AF (P=0.029). Multiple stepwise logistic regression analysis showed that metoprolol use, older age, and impaired left ventricular ejection fraction were independent risk factors for developing AF, and carvedilol use was found to be independently related to sinus rhythm maintenance after CABG (P=0.02).
These results show that carvedilol is superior to metoprolol in decreasing development of early postoperative AF.
冠状动脉旁路移植术（CABG）后心房颤动（AF）频繁发生，常导致术后住院时间延长、死亡率和发病率增加。已知β受体阻滞剂可预防术后房颤。在这项前瞻性研究中，我们比较了卡维地洛与琥珀酸美托洛尔预防术后房颤的疗效。
研究对象包括110例行CABG的患者（31名女性，79名男性；平均年龄60±10岁，范围39 - 82岁）。患者被随机分为接受美托洛尔或卡维地洛治疗，所有患者在手术前3天开始用药。美托洛尔起始剂量为每日两次，每次50mg；卡维地洛起始剂量为每日两次，每次12.5mg。根据患者的血流动力学反应调整剂量。所有患者术后监测3天。
110例患者中，55例（50%）接受琥珀酸美托洛尔治疗，55例（50%）接受卡维地洛治疗。两组患者的基线特征和手术数据无差异。随访期间，美托洛尔组20例患者（36%）发生房颤，卡维地洛组9例患者（16%）发生房颤（P = 0.029）。多步逻辑回归分析显示，使用美托洛尔、年龄较大和左心室射血分数受损是发生房颤的独立危险因素，而使用卡维地洛与CABG术后窦性心律维持独立相关（P = 0.02）。
这些结果表明，在降低术后早期房颤的发生率方面，卡维地洛优于美托洛尔。
