Document Detail


Comparison of sotalol and metoprolol in the prevention of atrial fibrillation after coronary artery bypass surgery.
MedLine Citation:
PMID:  9456279     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
New-onset atrial fibrillation (AF) is frequent after coronary artery bypass grafting (CABG), and beta-blockers decrease its incidence. To examine whether a beta-blocker with class III properties is superior to a pure one, 191 consecutive patients undergoing CABG were randomized to receive oral sotalol, 120 mg daily (n = 93), or metoprolol, 75 mg daily (n = 98), postoperatively. The doses were adjusted if beta-blockade was inadequate or excessive. AF occurred in 16 (16%) of 98 sotalol patients and in 30 (32%) of 93 metoprolol patients (p < 0.01). Symptoms related to beta-blockade or proarrhythmia did not appear. After CABG, sinus heart rate increased in both groups (p < 0.001) but less in the sotalol patients (p < 0.001) throughout the postoperative period. Corrected QT duration (by the Bazett equation) was prolonged after the operation in both groups (p < 0.001), whereas uncorrected QT duration at similar heart-rate levels were prolonged only in sotalol patients (mean increase, 31 ms; 95% confidence interval, 2042 ms; p < 0.01). Uncorrected QT durations at similar heart-rate levels were longer during sotalol (compared with metoprolol) treatment (p < 0.05). Heart rates or QT durations did not differ between the patients with or without AF. In conclusion, sotalol significantly reduces the incidence of AF after CABG. Although a marked class III effect is demonstrated with relatively low doses (as prolonged ventricular repolarization) in direct comparison unbiased by any rate correction, its contribution as an enhanced antifibrillatory mechanism in the postoperative state remains unconfirmed.
Authors:
H Parikka; L Toivonen; L Heikkilä; K Virtanen; A Järvinen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of cardiovascular pharmacology     Volume:  31     ISSN:  0160-2446     ISO Abbreviation:  J. Cardiovasc. Pharmacol.     Publication Date:  1998 Jan 
Date Detail:
Created Date:  1998-02-12     Completed Date:  1998-02-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7902492     Medline TA:  J Cardiovasc Pharmacol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  67-73     Citation Subset:  IM    
Affiliation:
Department of Medicine, Helsinki University Central Hospital, Finland.
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MeSH Terms
Descriptor/Qualifier:
Anti-Arrhythmia Agents / therapeutic use*
Atrial Fibrillation / epidemiology,  prevention & control*
Coronary Artery Bypass
Electrocardiography / methods
Female
Heart Rate / drug effects
Humans
Male
Metoprolol / therapeutic use*
Middle Aged
Single-Blind Method
Sotalol / therapeutic use*
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 37350-58-6/Metoprolol; 3930-20-9/Sotalol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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