Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized
T C Andrews1, S C Reimold, J A Berlin
1Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
Insights
Beta-blockers effectively prevent supraventricular arrhythmias (SVAs) after coronary artery bypass graft (CABG) surgery. Digoxin and verapamil did not reduce SVA likelihood, though all agents lowered ventricular rates during arrhythmias.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Supraventricular arrhythmias (SVAs) are common after coronary artery bypass graft (CABG) surgery.
- Prophylactic medications are used to prevent SVAs, but their efficacy varies.
Purpose of the Study:
- To evaluate the prophylactic efficacy of digoxin, verapamil, and beta-adrenoceptor blockers against SVAs post-CABG.
- To compare the effectiveness of these drug classes in preventing SVAs and controlling ventricular rate.
Main Methods:
- Meta-analysis of randomized controlled trials (RCTs) comparing prophylactic agents versus control groups.
- Included studies required defined electrocardiographic monitoring for at least 3 postoperative days.
- Calculated pooled odds ratios (OR) for SVA development and mean ventricular rates during SVAs.
Main Results:
- Neither digoxin (OR = 0.97) nor verapamil (OR = 0.91) significantly reduced the likelihood of SVAs post-CABG.
- Beta-blockers markedly decreased SVA likelihood (OR = 0.28) compared to controls.
- All three drug classes lowered the mean ventricular rate during SVAs, but not to an optimal level.
Conclusions:
- Prophylactic beta-adrenoceptor blockers demonstrate a protective effect against SVAs in patients undergoing CABG.
- Digoxin and verapamil showed no significant benefit in preventing SVAs post-CABG.
- While all agents reduced ventricular rate during SVAs, beta-blockers were most effective in prevention.
Abstract:
This meta-analysis was performed to determine the efficacy of digoxin, verapamil, and beta-adrenoceptor blockers as prophylaxis against supraventricular arrhythmias (SVAs) after coronary artery bypass graft surgery (CABG). Randomized control trials were included if the electrocardiographic monitoring technique was clearly defined and extended through at least the first 3 postoperative days. Twenty-four of 69 identified studies were included in the final analysis. A summary odds ratio (OR) of the likelihood of developing SVAs after CABG in the treatment versus control groups was calculated. The pooled mean ventricular rate during SVA in patients who developed such an arrhythmia was also calculated. Neither digoxin nor verapamil reduced the likelihood of SVAs after CABG (digoxin: OR = 0.97, 95% confidence interval [CI] = 0.62-1.49; verapamil: OR = 0.91, CI = 0.57-1.46). The likelihood of developing an SVA in patients treated with beta-blockers was markedly decreased compared with controls (OR = 0.28, CI = 0.21-0.36). The pooled ventricular rate when SVAs did occur was significantly lower in each of the treatment groups. Prophylactic beta-adrenoceptor blockers had a protective effect against the development of SVAs in a select population of patients undergoing CABG. No such beneficial effect was demonstrated for digoxin or verapamil. All three classes of agents reduced the ventricular rate in patients who developed the arrhythmia, although the ventricular rate reduction was not clinically optimal.
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