Prophylactic administration of low-dose landiolol did not significantly reduce the occurrence of postoperative atrial fibrillation in overall patients after cardiovascular surgery (p=0.256).
RCT (n=150)
Single-blind
Block randomization with block sizes of three
No
Does prophylactic intravenous landiolol prevent postoperative atrial fibrillation in patients over 70 years of age undergoing cardiovascular surgery?
Prophylactic low-dose landiolol did not significantly reduce the overall incidence of postoperative atrial fibrillation in older patients undergoing cardiovascular surgery, though subgroup analyses suggest potential benefit in females and those undergoing valve surgery.
Odds Ratio: 0.379 (95% CI 0.112–1.287)
Tasa de eventos absoluta: 11.1% vs 24.4%
valor p: p=0.256
OBJECTIVE: To investigate the efficacy of prophylactic administration of low-dose landiolol on postoperative atrial fibrillation (POAF) in patients after cardiovascular surgery. METHODS: Consecutive 150 patients over 70 years of age who underwent cardiovascular surgery for valvular, ischemic heart, and aortic diseases were enrolled in this single-center prospective randomized control study from 2010 to 2014. They were assigned to three treatment groups: 1γ group (landiolol at 1 μg/kg/min), 2γ group (landiolol at 2 μg/kg/min), or control group (no landiolol). In the two landiolol groups, landiolol hydrochloride was intravenously administered for a period of 4 days postoperatively. Electrocardiography was continuously monitored during the study period, and cardiologists eventually assessed whether POAF occurred or not. RESULTS: POAF occurred in 24.4% of patients in the control group, 18.2% in 1γ group, and 11.1% in 2γ group (p = 0.256). Multivariate logistic regression analysis showed that the incidence of POAF tended to decrease depending on the dose of landiolol (trend-p = 0.120; 1γ group: OR = 0.786, 95% CI 0.257-2.404; 2γ group: OR = 0.379, 95% CI 0.112-1.287). Subgroup analysis showed a significant dose-dependent reduction in POAF among categories of female sex, non-use of angiotensin II receptor blockers (ARBs) before surgery, and valve surgery (each trend-p = 0.02, 0.03, and 0.004). CONCLUSIONS: These findings indicate that prophylactic administration of low-dose landiolol may not be effective for preventing the occurrence of POAF in overall patients after cardiovascular surgery, but the administration could be beneficial to female patients, patients not using ARBs preoperatively, and those after valvular surgery.
Sasaki et al. (Tue,) conducted a rct in Postoperative atrial fibrillation (POAF) (n=150). Landiolol hydrochloride vs. No landiolol (control) was evaluated on Occurrence of POAF between postoperative day 1 and 4 (OR 0.379, 95% CI 0.112-1.287, p=0.256). Prophylactic administration of low-dose landiolol did not significantly reduce the occurrence of postoperative atrial fibrillation in overall patients after cardiovascular surgery (p=0.256).