Department of Cardiovascular Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2011 Jun;141(6):1478-87. doi: 10.1016/j.jtcvs.2010.10.045. Epub 2011 Jan 26.
Atrial fibrillation occurs frequently after cardiac surgery and not only prolongs hospitalization but also influences the prognosis. We investigated whether landiolol hydrochloride, an ultrashort-acting beta-blocker, could reduce postoperative atrial fibrillation in a randomized controlled trial.
The subjects were 140 patients undergoing coronary artery bypass grafting at the Nihon University School of Medicine. The primary end point was occurrence/non-occurrence of atrial fibrillation up to 1 week postoperatively. Logistic regression analysis was performed to investigate risk factors for atrial fibrillation among preoperative, perioperative, and postoperative variables.
Atrial fibrillation occurred in 7 patients (10%) in the landiolol group versus 24 patients (34.3%) in the placebo group; the landiolol group had a significantly lower incidence (P = .0006). Postoperative heart rate was significantly lower in the landiolol group than in the placebo group. On returning to the intensive care unit, the landiolol group had significantly lower inflammatory and ischemic parameters. Medical costs were also significantly lower in the landiolol group. Multivariate analysis revealed that significant risk factors for atrial fibrillation were a European System for Cardiac Operative Risk Evaluation of 10 or more, preoperative non-use of angiotensin receptor blockers, and non-use of landiolol.
Postoperative atrial fibrillation was reduced by treatment with landiolol hydrochloride. Amelioration of ischemia, an anti-inflammatory effect, and inhibition of sympathetic hypertonia by landiolol presumably reduced the occurrence of atrial fibrillation. Hypotension or bradycardia did not develop in any of the patients, indicating the safety of this beta-blocker. These findings suggest that landiolol hydrochloride could be useful in the perioperative management of patients undergoing cardiac surgery.
心房颤动在心脏手术后经常发生，不仅延长了住院时间，还影响了预后。我们研究了超短效β受体阻滞剂盐酸拉贝洛尔是否可以通过随机对照试验减少心脏手术后心房颤动的发生。
研究对象为日本大学医学院接受冠状动脉旁路移植术的 140 名患者。主要终点是术后 1 周内心房颤动的发生/未发生。采用逻辑回归分析对术前、术中和术后变量中与心房颤动相关的危险因素进行了调查。
在拉贝洛尔组中，有 7 例（10%）发生心房颤动，在安慰剂组中有 24 例（34.3%）发生心房颤动；拉贝洛尔组的发生率明显较低（P = 0.0006）。术后拉贝洛尔组心率明显低于安慰剂组。返回重症监护病房时，拉贝洛尔组的炎症和缺血参数明显较低。拉贝洛尔组的医疗费用也明显较低。多变量分析显示，心房颤动的显著危险因素是欧洲心脏手术风险评估系统（European System for Cardiac Operative Risk Evaluation）评分 10 分或更高、术前不使用血管紧张素受体阻滞剂和不使用拉贝洛尔。
盐酸拉贝洛尔治疗可减少术后心房颤动的发生。拉贝洛尔改善缺血、抗炎作用和抑制交感神经亢进可能减少心房颤动的发生。没有患者出现低血压或心动过缓，表明这种β受体阻滞剂是安全的。这些发现表明，盐酸拉贝洛尔可能对心脏手术患者的围手术期管理有用。
