Metoprolol versus low-dose sotalol for prevention of high-risk post coronary artery bypass grafting atrial fibrillation

Background: The optimal therapeutic strategy for high-risk postoperative atrial fibrillation (POAF) remains less well defined. Our objectives were to investigate the efficacy of prophylactic metoprolol versus low-dose sotalol regimens to prevent high-risk atrial fibrillation (AF) following coronary artery bypass surgery (CABG). Methods: We assigned 113 consecutive patients referred for CABG to either metoprolol or low-dose sotalol regimen. The primary end-point was the frequency of POAF during the 6-week follow-up. Results: Out of 113 patients enrolled, 52.2% % received metoprolol (n= 59) while 44.8% received sotalol (n= 54). The frequency of POAF at follow-up was significantly higher among the metoprolol group (59.3 % versus 50 %; P=0.017). The predictors of POAF were: age > 60 years (OR: 1.86 (1.01-4.41); P= 0.03), EF (OR: 2 (1.05-3.83); P= 0.02), and sotalol was protective against POAF (OR= 0.49%; (95% CI=0.25 -0.97); P=0.02). The length of hospital stay was significantly higher in the metoprolol group (7.5±1.3 % versus 6.1±1.2 days; P<0.001). Conclusion: Prophylactic low-dose sotalol could be superior to metoprolol for the prophylaxis of POAF in high-risk patients. However, Larger prospective multicenter randomized trials are needed to confirm our findings.