Nakanishi Kazuhiro, Takeda Shinhiro, Kim Chol, Kohda Shusuke, Sakamoto Atsuhiro
Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
J Cardiothorac Surg. 2013 Jan 24;8:19. doi: 10.1186/1749-8090-8-19.
Landiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF) after cardiac surgery.
Of the 200 consecutive patients whose records could be retrieved between October 2006 and September 2007, we retrospectively reviewed a total of 105 patients who met the inclusion criteria: no previous permanent/persistent AF, no permanent pacemaker, no renal insufficiency requiring dialysis, and no reactive airway disease, etc. Landiolol infusion was started after surgery had commenced, at an infusion rate of 1 μg/kg/min, titrated upward in 3-5 μg/kg/min increments. The patients were divided into 2 groups: those who received intraoperative β-blocker therapy with landiolol (landiolol group) and those who did not receive any β-blockers during surgery (control group). An unpaired t test and Fisher's exact test were used to compare between-group differences in mean values and categorical data, respectively.
Seventeen of the 105 patients (16.2%) developed postoperative atrial fibrillation: 5/57 (8.8%) in the landiolol group and 12/48 (25%) in the control group. There was a significant difference between the two groups (P=0.03). The incidence of AF after valve surgery and off-pump coronary artery bypass grafting was lower in the landiolol group, although the difference between the groups was not statistically significant.
Our retrospective review demonstrated a marked reduction of postoperative AF in those who received landiolol intraoperatively. A prospective study of intraoperative landiolol for preventing postoperative atrial fibrillation is warranted.
盐酸兰地洛尔是一种新型β-肾上腺素能阻滞剂，其药理学特性表明它可安全用于患有窦性心动过速或快速性心律失常且需要降低心率的患者。本研究旨在探讨术中给予兰地洛尔是否能降低心脏手术后房颤（AF）的发生率。
在2006年10月至2007年9月间可检索到记录的200例连续患者中，我们回顾性分析了共105例符合纳入标准的患者：既往无永久性/持续性房颤、无永久性起搏器、无需要透析的肾功能不全且无反应性气道疾病等。手术开始后开始输注兰地洛尔，输注速率为1μg/kg/min，以3 - 5μg/kg/min的增量向上滴定。患者分为两组：术中接受兰地洛尔β受体阻滞剂治疗的患者（兰地洛尔组）和术中未接受任何β受体阻滞剂的患者（对照组）。分别使用不成对t检验和Fisher精确检验比较组间均值和分类数据的差异。
105例患者中有17例（16.2%）发生术后房颤：兰地洛尔组5/57例（8.8%），对照组12/48例（25%）。两组间存在显著差异（P = 0.03）。兰地洛尔组瓣膜手术和非体外循环冠状动脉搭桥术后房颤的发生率较低，尽管组间差异无统计学意义。
我们的回顾性分析表明，术中接受兰地洛尔治疗的患者术后房颤明显减少。有必要对术中使用兰地洛尔预防术后房颤进行前瞻性研究。
