Intraoperative landiolol hydrochloride use for prevention of postoperative atrial fibrillation with off-pump coronary artery bypass graft surgery (ILUPAF-OPCAB) study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB) (n=233). Intervention: Landiolol hydrochloride vs. Control (historical cohort without landiolol protocol). Primary outcome: Postoperative atrial fibrillation (POAF) occurrence (p=0.02).

Satoshi Teranishi; Asako Matsushima; Koh Kajiyama; Shunsuke Sakamoto; Hisato Ito; Yasuhiro Sawada; Shinji Kanemitsu; Kazuya Fujinaga; Yu Shomura; Toru Mizumoto

doi:10.1007/s11748-026-02355-y

July 6, 2026General Thoracic and Cardiovascular SurgeryOpen Access

Intraoperative landiolol hydrochloride use for prevention of postoperative atrial fibrillation with off-pump coronary artery bypass graft surgery (ILUPAF-OPCAB) study

View Full Paper

Ask AI

Bookmark

Share

Key result

Perioperative landiolol is linked to ~55% less postoperative AF after off-pump CABG.

P=0.02
n=233

Why the study?

Postoperative atrial fibrillation remains a common complication after off-pump coronary artery bypass grafting, prompting evaluation of short-term perioperative landiolol hydrochloride for its prevention.

Does short-term perioperative continuous intravenous infusion of landiolol hydrochloride reduce the occurrence of postoperative atrial fibrillation in patients undergoing elective isolated off-pump coronary artery bypass grafting?

Key Points

To evaluate whether short-term perioperative administration of landiolol hydrochloride prevents postoperative atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting.
Retrospective observational study of patients undergoing elective isolated off-pump coronary artery bypass between February 2013 and August 2018 (74 control, 159 landiolol; 68 matched pairs following propensity score matching).
Continuous landiolol hydrochloride was infused from the start of surgery until postoperative day 1 at a median dose ranging from 1.1 to 3.2 μg/kg/min.
The primary endpoint was the occurrence of postoperative atrial fibrillation; secondary endpoints assessed hospital stay, perioperative complications, and medical insurance reimbursement points.
Postoperative atrial fibrillation incidence was significantly lower with landiolol in both the unadjusted cohort (15.7% vs. 31.1%, p = 0.01) and the propensity score matched cohort (14.7% vs. 32.4%, p = 0.02).
No significant differences were identified in hospital stay (14 vs. 14 days, p = 0.30 in matched pairs) or major complications including 30-day mortality (0% vs. 0%), stroke (0% vs. 2.7%, p = 0.25), and intubation lasting over 48 hours.
Healthcare insurance reimbursement points were significantly lower in the matched landiolol group compared with the control group (258,460 vs. 267,904 points, p = 0.047).

Study Design

Type

Observational (n=233)

Multicenter

No

Structured PICO

Does short-term perioperative continuous intravenous infusion of landiolol hydrochloride reduce the occurrence of postoperative atrial fibrillation in patients undergoing elective isolated off-pump coronary artery bypass grafting?

P

Population

233 patients undergoing elective isolated off-pump coronary artery bypass grafting, free of prior atrial fibrillation, evaluated for the preventive effect of landiolol hydrochloride on postoperative atrial fibrillation.

E

Exposure

Continuous intravenous infusion of landiolol hydrochloride, starting at 1-2 μg/kg/min (median dose 1.1-3.2 μg/kg/min) from the initiation of OPCAB surgery until oral β-blockade was completed on postoperative day 1.

C

Comparator

Control group receiving standard care without landiolol hydrochloride during a period when the cardiac surgery team remained constant.

O

Outcome

Occurrence of postoperative atrial fibrillation (POAF), defined as atrial fibrillation and atrial flutter lasting more than 5 min after surgery or requiring treatment due to symptoms or hemodynamic changes.hard clinical

Main Result

Absolute Event Rate: 14.7% vs 32.4%

p-value: p=0.02

Limitations

Non-randomized observational pre-and-post comparative study conducted at a single facility without double-blinding
Limited number of cases, making power analysis impossible
Focus solely on patients undergoing scheduled OPCAB surgery, which may not be universally applicable to open-heart surgery
Unable to retrieve and adjust for detailed individual data on perioperative medications, such as specific intraoperative anesthetics, catecholamines, and perioperative diuretics
Specific indicators for determining the dosage of landiolol hydrochloride during surgery were not identified
Non-randomized observational pre-and-post comparative study
Single facility without double-blinding
Limited sample size
Focus solely on scheduled OPCAB surgery
Unmeasured pharmacological confounders (e.g., specific intraoperative anesthetics, catecholamines, and perioperative diuretics)

Implication

Short-term perioperative administration of landiolol hydrochloride significantly reduced the incidence of postoperative atrial fibrillation and lowered medical insurance costs in patients undergoing off-pump coronary artery bypass grafting.

Abstract

OBJECTIVE: Postoperative atrial fibrillation (POAF) remains a common complication after off-pump coronary artery bypass grafting (OPCAB). We evaluated the preventive effect of short-term perioperative landiolol hydrochloride administration on POAF after OPCAB. METHODS: This single-center retrospective observational study included patients who underwent elective isolated OPCAB between February 2013 and August 2018. Patients with a history of atrial fibrillation, emergency surgery, or conversion to cardiopulmonary bypass were excluded. Landiolol hydrochloride was continuously administered from the beginning of surgery until postoperative day 1. The primary endpoint was POAF occurrence. Secondary endpoints included hospital stay, perioperative complications, and healthcare insurance reimbursement points. Propensity score matching was performed to adjust baseline differences. RESULTS: Among eligible patients, 74 were assigned to the control group and 159 to the landiolol group. Propensity score matching generated 68 matched pairs. POAF incidence was significantly lower in the landiolol group in both the unadjusted cohort (15.7% vs. 31.1%, p = 0.01) and propensity score matched cohort (14.7% vs. 32.4%, p = 0.02). No significant differences were observed in hospital stay or major clinical outcomes, including 30-day mortality, stroke, and prolonged intubation. However, medical insurance points were significantly lower in the matched intervention group (258,460 vs. 267,904 points, p = 0.047). CONCLUSIONS: Short-term perioperative administration of landiolol hydrochloride was associated with a lower incidence of POAF after OPCAB without an increase in perioperative complications. While further prospective randomized studies are needed, this simplified protocol may offer a safe, feasible, and potentially cost-favorable strategy for POAF prevention after cardiac surgery.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Teranishi et al. (2026) conducted an observational in Postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB) (n=233). Landiolol hydrochloride vs. Control (historical cohort without landiolol protocol) was evaluated on Postoperative atrial fibrillation (POAF) occurrence (p=0.02). Short-term perioperative administration of landiolol hydrochloride reduced the incidence of postoperative atrial fibrillation to 14.7% compared to 32.4% in the matched control group after off-pump coronary artery bypass grafting.

synapsesocial.com/papers/6a4de93fd2ea289ef628378a https://doi.org/10.1007/s11748-026-02355-y

View Full Paper

Ask AI

Bookmark

Share

Intraoperative landiolol hydrochloride use for prevention of postoperative atrial fibrillation with off-pump coronary artery bypass graft surgery (ILUPAF-OPCAB) study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Intraoperative landiolol hydrochloride use for prevention of postoperative atrial fibrillation with off-pump coronary artery bypass graft surgery (ILUPAF-OPCAB) study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading