Does prophylactic sotalol and magnesium decrease the incidence of atrial fibrillation following coronary artery bypass surgery: a propensity-matched analysis

Journal of Cardiothoracic Surgery, Mar 2006

Background Atrial fibrillation can occur in up to 40% of patients undergoing coronary surgery. Methods We retrospectively analysed 103 consecutive coronary surgery patients under the care of one surgeon between April 2003 and September 2003. These patients received 40 mg of sotalol orally twice daily from the first post-operative day for 6 weeks and 2 g of magnesium intravenously immediately post surgery and on the first post-operative day. We developed a propensity score for the probability of receiving sotalol and magnesium after coronary surgery. 89 patients from the sotalol and magnesium group were successfully matched with 89 unique coronary surgery patients who did not receive either sotalol or magnesium with an identical propensity score. Results Preoperative characteristics were well matched between groups. There was no significant difference with respect to in-hospital mortality between groups (sotalol and magnesium 1.1% versus control 4.5%; p = 0.17). The incidence of atrial fibrillation in the sotalol and magnesium group was 13.5% compared to 27.0% in the controls (p = 0.025). Conclusion The combination of sotalol and magnesium can significantly reduce the incidence of post-operative atrial fibrillation following coronary surgery.

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Does prophylactic sotalol and magnesium decrease the incidence of atrial fibrillation following coronary artery bypass surgery: a propensity-matched analysis

V Aerra 2 M Kuduvalli 2 AN Moloto 2 AK Srinivasan 2 AD Grayson 0 1 Fabri 2 AY Oo 2 0 Senior Clinical Information Analyst, Clinical Governance Department. The Cardiothoracic Centre- Liverpool , Thomas Drive, Liverpool, L14 3PE , UK 1 Department of Research and Development. The Cardiothoracic Centre Liverpool , UK 2 Department of Cardiothoracic Surgery. The Cardiothoracic Centre Liverpool , UK Background: Atrial fibrillation can occur in up to 40% of patients undergoing coronary surgery. Methods: We retrospectively analysed 103 consecutive coronary surgery patients under the care of one surgeon between April 2003 and September 2003. These patients received 40 mg of sotalol orally twice daily from the first post-operative day for 6 weeks and 2 g of magnesium intravenously immediately post surgery and on the first post-operative day. We developed a propensity score for the probability of receiving sotalol and magnesium after coronary surgery. 89 patients from the sotalol and magnesium group were successfully matched with 89 unique coronary surgery patients who did not receive either sotalol or magnesium with an identical propensity score. Results: Preoperative characteristics were well matched between groups. There was no significant difference with respect to in-hospital mortality between groups (sotalol and magnesium 1.1% versus control 4.5%; p = 0.17). The incidence of atrial fibrillation in the sotalol and magnesium group was 13.5% compared to 27.0% in the controls (p = 0.025). Conclusion: The combination of sotalol and magnesium can significantly reduce the incidence of post-operative atrial fibrillation following coronary surgery. - Introduction Atrial Fibrillation is the most common complication following cardiac surgery with a reported incidence between 20% and 40% [1,2]. It usually occurs between the second and fourth post-operative day. However, although this complication occurs frequently, the mechanism behind its development is less understood. Numerous studies have identified and enumerated a variety of risk factors for the development of atrial fibrillation. These include increased age, male gender, history of atrial fibrillation, discontinuation of preoperative eta-blocker therapy, congestive heart failure, electrolyte depletion (low potassium and magnesium), cardiopulmonary bypass, left atrial dysfunction, severity of coronary artery In an effort to prevent the occurrence of atrial fibrillation in the post-operative period, various treatment modalities have been implemented indicating its unclear pathophysiology. The key role of eta blockers in prevention of atrial fibrillation is well recognised in many randomised control trials [8,9]. Sotalol has an acceptable safety profile and is emerging as a key drug in the prevention of this complication [9,10]. The role of magnesium supplements is less clear [11-17]. The present study was done to examine the beneficial role of sotalol and magnesium prophylaxis in the prevention of atrial fibrillation in routine coronary artery bypass graft (CABG) surgery. Materials and methods Patient population Between 1st April 2003 and 30th September 2003, 103 consecutive patients undergoing first time isolated CABG surgery under the care of one surgeon (AYO) were routinely administered sotalol and magnesium (see sotalol and magnesium). These patients were matched to a control group taken from the remaining 487 consecutive patients who SM (n = 89) received first time isolated CABG surgery performed during the same time period by other surgeons at our institution (see statistical methods). Exclusions Patients undergoing CABG that was in addition to heart valve repair or replacement, resection of a ventricular aneurysm or other surgical procedure were not included. Also excluded were patients who had received previous cardiac surgery or patients with a history of atrial arrhythmias. Data collection Definitions and data collection methods are available from http://www.nwheartaudit.nhs.uk. Data was collected prospectively during the patient's admission as part of routine clinical practice and entered into our cardiac surgery registry on the variables listed in Table 1. Postoperative atrial fibrillation, in-hospital mortality, and length of hospital stay were also documented. Sotalol and Magnesium Patients received 40 mg of sotalol orally twice daily from the first post-operative day for 6 weeks and 2 g of magnesium intravenously immediately post-coronary surgery Control (n = 89) SM, Sotalol and Magnesium; CPB, Cardiopulmonary Bypass; EuroSCORE, European System for Cardiac Operative Risk Evaluation; CAD, Coronary Artery Disease; LIMA, Left Internal Mammary Artery. Categorical variables are shown as a percentage. Continuous variables are shown as a median with 25th and 75th percentiles. PFrigoupernes1ity-matched incidence of atrial fibrillation Propensity-matched incidence of atrial fibrillation. and on the first post-operative day. No patients from the con (...truncated)


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V Aerra, M Kuduvalli, AN Moloto, AK Srinivasan, AD Grayson, BM Fabri, AY Oo. Does prophylactic sotalol and magnesium decrease the incidence of atrial fibrillation following coronary artery bypass surgery: a propensity-matched analysis, Journal of Cardiothoracic Surgery, 2006, pp. 6, 1, DOI: 10.1186/1749-8090-1-6