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January 1, 1998Journal of Cardiovascular Pharmacology

Comparison of Sotalol and Metoprolol in the Prevention of Atrial Fibrillation After Coronary Artery Bypass Surgery

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Why the study?

Does sotalol reduce the incidence of new-onset atrial fibrillation compared to metoprolol in patients after coronary artery bypass surgery?

Population

191 consecutive patients undergoing coronary artery bypass grafting (CABG)

Comparison

Oral sotalol, 120 mg daily postoperatively vs Oral metoprolol, 75 mg daily postoperatively

Design

RCT, randomized

Follow-up

postoperative period

Authors

HPHannu ParikkaUniversity of HelsinkiLTL. ToivonenTampere University HospitalLHL. HeikkiläUniversity of Helsinki

Discussion

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Implication

Sotalol may be preferred over metoprolol to prevent post-CABG AF; extends randomized evidence for added class III benefit.

Key Points

  • To determine whether sotalol, an agent with combined beta-blocking and class III antiarrhythmic properties, is superior to pure beta-blocker metoprolol in preventing postoperative atrial fibrillation after coronary artery bypass grafting.
  • Randomized trial of 191 consecutive patients undergoing coronary artery bypass grafting assigned postoperatively to oral sotalol (120 mg daily, n=93) or oral metoprolol (75 mg daily, n=98).
  • Doses were adjusted if beta-blockade was inadequate or excessive, with continuous monitoring for arrhythmias, heart rate, and QT intervals.
  • Atrial fibrillation occurred in 16% (16/98) of sotalol patients compared with 32% (30/93) of metoprolol patients (p < 0.01), with no observed proarrhythmia or excess symptoms.
  • Uncorrected QT duration at similar heart rates was prolonged only in sotalol-treated patients (mean increase: 31 ms, 95% CI: 20–42 ms; p < 0.01) and was longer than in metoprolol-treated patients (p < 0.05).
  • Sinus heart rate increased postoperatively in both groups (p < 0.001) but remained lower in the sotalol group throughout the postoperative phase (p < 0.001).

Structured PICO

Does sotalol reduce the incidence of new-onset atrial fibrillation compared to metoprolol in patients after coronary artery bypass surgery?

P
Population
191 consecutive patients undergoing coronary artery bypass grafting (CABG)
I
Intervention
Oral sotalol, 120 mg daily postoperatively (dose adjusted if beta-blockade inadequate or excessive)
C
Comparator
Oral metoprolol, 75 mg daily postoperatively (dose adjusted if beta-blockade inadequate or excessive)
O
Outcome
Incidence of new-onset atrial fibrillation (AF)hard clinical

Sotalol significantly reduces the incidence of postoperative atrial fibrillation compared to metoprolol in patients undergoing CABG.

Cite This Study

Parikka et al. (1998) studied this question.

synapsesocial.com/papers/6a777733f6b553d308ae8539https://doi.org/10.1097/00005344-199801000-00010

Topics

Persistent AF managementAtrial fibrillationAnticoagulation in AFAF ablation outcomes
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The use of atenolol in the prevention of supraventricular arrhythmias following coronary artery surgery1988 · 99 citations
  2. 2QT intervals at heart rates from 50 to 120 beats per minute during 24-hour electrocardiographic recordings in 100 healthy men. Effects of atenolol.1992 · 83 citations
  3. 3Prevention and Treatment of Supraventricular Tachycardia Shortly After Coronary Artery Bypass Grafting: A Randomized Open Trial1986 · 110 citations
  4. 4Efficacy of Low-dose Propranolol in Preventing Postoperative Supraventricular Tachyarrhythmias1982 · 102 citations