Fujii M, Bessho R, Ochi M, Shimizu K, Terajima K, Takeda S
Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
J Cardiovasc Surg (Torino). 2012 Jun;53(3):369-74. Epub 2012 Jan 17.
Atrial fibrillation is one of the most common postoperative arrhythmias following cardiac surgery. Despite many clinical studies, there is still no consensus on the most appropriate prevention strategy for atrial arrhythmia. A randomized prospective trial was conducted to determine the efficacy of intravenous landiolol administration in the early period after off-pump coronary artery bypass grafting (CABG) followed by treatment with carvedilol for prevention of atrial fibrillation.
Seventy consecutive patients were enrolled in the study prospectively. Patients in the treated group received landiolol intravenously (5 μg/kg/min) in the ICU immediately after surgery. Heart rate was maintained at 60-80 bpm and intravenous landiolol was continued at 0-10 μg/kg/min until oral drug administration was possible. All patients received oral carvedilol (2.5-5 mg/day) after extubation and this was continued postoperatively. The primary endpoint was the overall development of postoperative atrial fibrillation.
Postoperative atrial fibrillation occurred in 4 (11.1%) of the 36 patients in the landiolol group, compared with 11 (32.3%) of the 34 patients in the control group, indicating that development of atrial fibrillation was significantly inhibited by landiolol (P=0.042). No major postoperative complications occurred in the landiolol group.
Postoperative intravenous landiolol therapy followed by oral carvedilol may be more effective than oral carvedilol alone for prevention of atrial fibrillation after off-pump CABG. We also found that intravenous landiolol is well tolerated after cardiac surgery.
心房颤动是心脏手术后最常见的术后心律失常之一。尽管有许多临床研究，但对于心房心律失常最合适的预防策略仍未达成共识。进行了一项随机前瞻性试验，以确定静脉注射兰地洛尔在非体外循环冠状动脉旁路移植术（CABG）后早期的疗效，随后用卡维地洛治疗以预防心房颤动。
前瞻性地连续纳入70例患者。治疗组患者术后立即在重症监护病房静脉注射兰地洛尔（5μg/kg/分钟）。心率维持在60-80次/分钟，静脉注射兰地洛尔以0-10μg/kg/分钟的速度持续，直到可以口服药物。所有患者拔管后均接受口服卡维地洛（2.5-5mg/天），术后持续使用。主要终点是术后心房颤动的总体发生情况。
兰地洛尔组36例患者中有4例（11.1%）发生术后心房颤动，而对照组34例患者中有11例（32.3%）发生，这表明兰地洛尔显著抑制了心房颤动的发生（P=0.042）。兰地洛尔组未发生重大术后并发症。
非体外循环CABG术后静脉注射兰地洛尔治疗后口服卡维地洛可能比单独口服卡维地洛更有效地预防心房颤动。我们还发现心脏手术后静脉注射兰地洛尔耐受性良好。
