postcabgatrialfibrillationflutter(編輯修改稿)
2024-11-17 15:11 本頁面
【文章內(nèi)容簡介】 *Abnormal LA size 19 ()+ 38 ()+ 2 (14) Preop Beta Blockers 35 (66) 87 () 2 () Preop Digoxin 3 () 1 () () Off pump CABG 27(51) 97(54) () Aortic clamp time (min) 177。 177。 Number of Anastomoses 177。 177。 Results ? 53 of 231 (23%) patients undergoing CABG with or without valvular surgery developed AF during postoperative period. ? Cases were older than controls (mean age 72 vs. 64, p ). ? On bivariate analysis, multiple factors were found to predispose to the development of AF. Effectiveness of BB therapy ? In terms of prophylactic therapy, 35 of 53 (66%) cases were taking BB as pared to 87 of 178 (48%) of controls (p=). ? But on multivariate analysis only Age (p=) and BNP (p=) were found to be independent predictors for the development of post CABG AF. Effectiveness of BB therapy Variable On BB(122) Not on BB(109) P value Age (mean) 177。 177。 Abnormal BNP 7 5 Abnormal EF 16 20 AF at disharge 13 6 Post op AF 35 18 AVR 5 5 1 Statin 91 41 h/o AF 18 2 h/o CHF 7 6 1 h/o/ CAD 60 35 h/o COPD 11 10 1 h/o DM 46 24 Dyslipidemia 97 63 HTN 105 64 Sex (male) 78 81 Conclusion ? We concluded that advanced age, history of AF, enlarged left atrial size, history of CHF and elevated BNP levels as predictors for the development of post CABG AF. ? In terms of prophylactic beta blocker therapy, 35 of 122 (%) developed AF while on beta blocker whereas only 18 of 109 (%) developed AF in the absence of prophylactic beta blockers. However, on multivariate analysis, this predisposing effect was not significant. ? Based on this analysis, BB did not show protection against post CABG AF. Limitations ? Retrospective chart review analysis. ? The patient population is small. ? Belongs to a single munity hospital thus the data and results derived may not be generalized to reflect other cardiac surgery centers. Possible reasons for BB ineffectiveness ? Decreased oral bioavailability of these drugs during perioperative period ? ? Is there any difference among different class of BB ? ? IV BB better than oral BB? Decreased Metoprolol bioavailability Valtola A, Kokki H, Gergov M, Ojanper228。 I, Ranta VP, Hakala T. Eur J Clin Pharmacol. 2020 May。63(5):4718. Epub 2020 Feb 28. Hypotheses ? If blood levels of oral MPL are lowest on first postoperative day, then it should create an effect similar to BB withdrawal. (BB withdrawal has been shown to predispose to the development of Post CABG AF). ? Prophylactic BB started on postoperative period should prevent AF better than preoperative BB due to lack of this withdrawal
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