Document Detail

Selective versus non-selective antiarrhythmic approach for prevention of atrial fibrillation after coronary surgery: is there a need for pre-operative risk stratification? A prospective placebo-controlled study using low-dose sotalol.
MedLine Citation:
PMID:  9717015     Owner:  NLM     Status:  MEDLINE    
AIM: This study evaluated the advantages of 'selective' over 'non-selective' antiarrhythmic prevention of atrial fibrillation after coronary surgery based on a new risk prediction algorithm. METHODS AND RESULTS: In a retrospective analysis of a prospective randomized trial, a model for risk prediction was determined based on clinical data of the control group (A; n = 107) and tested in a test group (B; n = 107, treated with low dose sotalol). Using this algorithm, the effect of a 'selective' antiarrhythmic approach in high-risk patients was compared to a 'non-selective' approach, where all patients were treated. In total, 75 (35%) patients developed atrial fibrillation and 14 (7%) side-effects led to discontinuation of study medication. Based on the risk prediction algorithm, 36% of group A patients were classified as high-risk patients with an incidence of atrial fibrillation of 76% compared to 26% in low-risk patients (P < 0.0001). The selective approach, i.e. treatment of high-risk patients only reduced the incidence of atrial fibrillation from 76% to 50% (P = 0.0295) compared to a reduction from 44% to 26% (P = 0.0065) when all patients were treated. More importantly, with the non-selective approach 100% of patients were exposed to the possible side-effects of sotalol and costs compared to 24% only with the selective approach (P < 0.0001). CONCLUSIONS: Thus, a selective approach based on a clinical risk prediction algorithm should improve the cost-effectiveness and safety of low-dose sotalol in the prevention of atrial fibrillation after coronary bypass surgery.
U K Weber; S Osswald; M Huber; P Buser; K Skarvan; P Stulz; C Schmidhauser; M Pfisterer
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European heart journal     Volume:  19     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-12-11     Completed Date:  1998-12-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  794-800     Citation Subset:  IM    
Department of Internal Medicine, University Hospital, Basel, Switzerland.
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MeSH Terms
Anti-Arrhythmia Agents / administration & dosage*,  adverse effects
Atrial Fibrillation / diagnosis,  prevention & control*
Coronary Artery Bypass*
Dose-Response Relationship, Drug
Double-Blind Method
Electrocardiography / drug effects
Middle Aged
Postoperative Complications / diagnosis,  prevention & control*
Prospective Studies
Risk Assessment
Sotalol / administration & dosage*,  adverse effects
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 3930-20-9/Sotalol
Comment In:
Eur Heart J. 1999 Feb;20(4):317   [PMID:  10099927 ]
Eur Heart J. 1998 May;19(5):684-5   [PMID:  9716997 ]

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