The online version of this article (doi:10.1007/s40119-013-0024-1) contains supplementary material, which is available to authorized users.
In patients with conduction abnormalities or left ventricle (LV) dysfunction the use of β-blockers for post cardiac surgery rhythm control is difficult and controversial, with a paucity of information about other drugs such ivabradine used postoperatively. The objective of this study was to compare the efficacy and safety of ivabradine versus metoprolol used perioperatively in cardiac surgery patients with conduction abnormalities or LV systolic dysfunction.
This was an open-label, randomized clinical trial enrolling 527 patients with conduction abnormalities or LV systolic dysfunction undergoing coronary artery bypass grafting or valvular replacement, randomized to take ivabradine or metoprolol, or metoprolol plus ivabradine. The primary endpoints were the composites of 30-day mortality, in-hospital atrial fibrillation (AF), in-hospital three-degree atrioventricular block and need for pacing, in-hospital worsening heart failure (HF; safety endpoints), duration of hospital stay and immobilization and the above endpoint plus in-hospital bradycardia, gastrointestinal symptoms, sleep disturbances, cold extremities (efficacy plus safety endpoint).
Heart rate reduction and prevention of postoperative AF or tachyarrhythmia with combined therapy was more effective than with metoprolol or ivabradine alone during the immediate postoperative management of cardiac surgery patients. In the Ivabradine group, the frequency of early postoperative pacing and HF worsening was smaller than in the Metoprolol group and in combined therapy group. The frequency of primary combined endpoint was lower in the combined Ivabradine + Metoprolol group compared with the monotherapy groups.
Considering efficacy and safety, the cardiac rhythm reduction after open heart surgery in patients with conduction abnormalities or LV dysfunction with ivabradine plus metoprolol emerged as the best treatment in this trial.
Mina K, Chung MD. Cardiac surgery: postoperative arrhythmias. Crit Care Med. 2000;28(10 Suppl):N136–44.
Mathew JP, Fontes ML, Tudor IC, et al. AF after coronary artery surgery—a multicenter risk index for AF after cardiac Surgery. Am Heart J. 2004;147:636–43. CrossRef
Stebbins D, Igidbashian L, Goldman SM, et al. Clinical outcome of patients who develop AF after coronary artery bypass graft surgery. PACE. 1995;18:798.
Aranski SF, ShawDP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M. Predictors of AF after coronary artery surgery. Current trends and impact on hospital resources. Circulation 1996;94:390–7.
Ascione R, Caputo M, Calori G, Lloyd CT, Underwood MJ, Angelini GD. Predictors of AF after conventional and beating heart coronary surgery: a prospective, randomized study. Circulation. 2000;102:1530–5.
Iliuta L, Christodorescu R, Filipescu D, et al. Prevention of perioperative AF with betablockers in coronary surgery: betaxolol versus metoprolol. Interact Cardiov Thorac Surg. 2010;9:89–93. CrossRef
Lucio Ede A, Flores A, Blacher C, et al. Effectiveness of metoprolol in preventing AF and flutter in the postoperative period of coronary artery bypass graft surgery. Arquivos Brasileiros de Cardiologia. 2004;82:42–46; 37–41.
Matangi MF, Neutze JM, Graham KJ, et al. Arrhythmia prophylaxis after aorto-coronary bypass: the effect of minidose propanolol. J Thorac Cardiov Sur. 1985;89:439–43.
Crystal E, Garfinkle MS, Connolly SS, et al.: Interventions for preventing post-operative AF in patients undergoing heart surgery. Cochrane Database Syst Rev. 2004(4), Art. No.CD003611.
Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation. 2004;110:340–437. CrossRef
Swedberg K, Komajda M, Böhm M, et al. SHIFT Investigators: Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet. 2010;9744:875–85. CrossRef
Fox K, Ford I, Steg PG, BEAUTIFUL Investigators, et al. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. Lancet. 2008;9641:807–16. CrossRef
Iliuta L, Enache R. Ivabradine versus beta-blockers in patients with conduction abnormalities or left ventricular dysfunction undergoing coronary artery bypass grafting. InTech Publishing. 2011, p. 355–368.
Reed G III, Singer DE, Picard EH, DeSanctis RW. Stroke following coronary-artery bypass surgery. A case-control estimate of the risk from carotid bruits. New Engl J Med. 1988;319:1246–50.
Lamb RK, Prabhakar G, Thorpe JA, et al. The use of atenolol in the prevention of supraventricular arrhythmias following coronary artery surgery. Eur Heart J. 1988;9:32–36.
Kamei M, Morita S, Hayashi Y, et al. Carvedilol versus metoprolol for the prevention of AF after off-pump coronary bypass surgery: rationale and design of the carvedilol or metoprolol post-revascularization AF controlled trial (COMPACT). Cardiovasc Drug Ther. 2006;20:219–27. CrossRef
Parikka H, Toivonen L, Heikkila L, et al. Comparison of sotalol and metoprolol in the prevention of AF after coronary artery bypass surgery. J Cardiovasc Pharm. 1998;31:67–73. CrossRef
Suttorp MJ, Kingma JH, Tjon Joe Gin RM, et al. Efficacy and safety of low- and high-dose sotalol versus propranolol in the prevention of supraventricular tachyarrhythmias early after coronary artery bypass operations. J Thorac Cardiov Surg. 1990;100:921–26.
- Ivabradine Versus Beta-Blockers in Patients with Conduction Abnormalities or Left Ventricular Dysfunction Undergoing Cardiac Surgery
- Springer Healthcare
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