Key result
Postoperative use of beta-blockers within 24 hours after aortic valve replacement was associated with a reduced risk of postoperative atrial fibrillation (OR 0.354; 95% CI 0.163-0.770; P=0.009).
Why the study?
Guidelines recommend perioperative beta-blockers to prevent POAF based primarily on CABG trials, leaving their impact after aortic valve replacement uncertain.
Does postoperative use of beta-blockers within 24 hours after AVR prevent postoperative atrial fibrillation in patients undergoing aortic valve replacement?
Cohort (n=296)
No
Does postoperative use of beta-blockers within 24 hours after AVR prevent postoperative atrial fibrillation in patients undergoing aortic valve replacement?
Odds Ratio: 0.354 (95% CI 0.163–0.77)
p-value: p=0.009
Postoperative administration of beta-blockers within 24 hours after aortic valve replacement is associated with a significantly reduced risk of postoperative atrial fibrillation.
Postoperative BB initiation within 24 hours was associated with lower POAF after AVR; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Current guidelines recommend perioperative use of beta-blocker (BB) in patients undergoing cardiac surgery to prevent postoperative atrial fibrillation (POAF). However, this recommendation is mainly based on studies those exclusively enrolled patients undergoing coronary artery bypass grafting. This study was conducted to evaluate the impact of perioperative BB use on the occurrence of POAF after aortic valve replacement (AVR). METHODS: From January 2015 to June 2018, 296 patients (male: female = 163:133) who underwent AVR at our institution were retrospectively reviewed. Patients who underwent concomitant valve surgery other than AVR or patients with preoperative arrhythmia were excluded. Mean age at the operation was 67±12 years. All patients were continuously tele-monitored for the occurrence of AF until discharge. Occurrence of any short runs of AF during the hospital stay was treated as POAF. Early outcomes were evaluated and perioperative factors associated with POAF were analyzed using a multivariable logistic regression model. RESULTS: Early mortality rate was 3.7% (11 of 296 patients). The POAF occurred in 154 patients (52.0%). Univariate analyses demonstrated that postoperative use of BB as well as age, type of prosthesis, history of stroke, body surface area, and chronic kidney disease were associated with the occurrence of POAF. The multivariable model showed that postoperative use of BB within 24 hours after AVR was a preventive factor of POAF (odds ratio, 0.354; 95% CI, 0.163 to 0.770; P=0.009). CONCLUSIONS: Postoperative use of BB within 24 hours after AVR rather than preoperative use might be effective in prevention of POAF.
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Kim et al. (2020) conducted a cohort in Aortic valve replacement (n=296). Postoperative use of beta-blocker within 24 hours vs. No postoperative beta-blocker use within 24 hours was evaluated on Postoperative atrial fibrillation (POAF) (OR 0.354, 95% CI 0.163 to 0.770, p=0.009). Postoperative use of beta-blockers within 24 hours after aortic valve replacement was associated with a reduced risk of postoperative atrial fibrillation (OR 0.354; 95% CI 0.163-0.770; P=0.009).
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