Atrial Fibrillation After Coronary Artery Bypass Surgery: Can Ivabradine Reduce Its Occurrence?

INTRODUCTION: We compared the efficacy of perioperative ivabradine, bisoprolol, or both for prevention of postoperative atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting (CABG). METHODS AND RESULTS: We enrolled 740 consecutive patients scheduled for elective CABG with/without valve surgery. Patients were assigned to 1 of 3 protocols: ivabradine given perioperatively (48 hours preoperatively, then 1 week postoperatively) 5 mg bid for 24 hours, then 7.5 mg bid thereafter in patients who can tolerate (group 1, n = 212); bisoprolol given perioperatively 5 mg bid (group 2, n = 288); or both drugs given perioperatively (ivabradine as before + bisoprolol 5 mg once daily) (group 3, n = 240). Cardiac rhythm was continuously monitored for 15 days postoperatively by ambulatory event recorder. Clinical follow-up for the occurrence of arrhythmias was performed for the next 15 days. The primary endpoint was the incidence of AF at 30-day follow-up. Mean age was 56.5 ± 8.9 years (30.5% females). All patients completed 30-day follow-up. AF occurred in 10.4%. The 3 groups were matched for most baseline characteristics, echocardiographic and angiographic data (P > 0.05 for all). The incidence of AF was significantly lower in group 3 (4.2%), compared with group 1 (15.5%), and group 2 (12.2%), (P < 0.001 both). The duration of stay in the intensive care unit was shorter in group 3 versus group 1 and 2 (P < 0.001 both). CONCLUSION: In patients undergoing elective CABG, adding ivabradine to β-blockers during the perioperative period was associated with reduced incidence of AF at 30-day follow-up, compared with either medication alone.