Related Experiment Video
Updated: Apr 17, 2026
Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
Prophylaxis with diltiazem decreases arrhythmia rate when compared to beta-blocker following lobectomy
Adam R Dyas1,2, Christina M Stuart1,2, Kyle E Bata1
1Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Background:
There is mixed evidence supporting arrhythmia prophylaxis after lobectomy in patients not taking preoperative beta-blockers (BBs). We sought to determine the safety and efficacy of postoperative-BB versus diltiazem in BB-naïve patients in preventing post-lobectomy arrhythmia.
Methods:
This was a cohort study at one academic medical center (01/2019-03/2023). All patients undergoing elective lobectomy were included. Before May 2021, all patients undergoing lobectomy received low dose oral metoprolol postoperatively for arrhythmia prophylaxis. After May 2021, patients were started on oral diltiazem postoperatively unless they were receiving BB preoperatively, in which case their BB was continued. Patients were divided into pre-implementation versus post-implementation groups. The primary outcome was the rate of postoperative arrhythmia; secondary outcomes were the rates of postoperative heart failure, nonhome discharge, stroke and hypotension. Bivariable and multivariable logistic regression comparisons were performed.
Results:
In total, 606 patients were included; 318 patients (52.5%) were in the pre-implementation cohort. There were minimal differences in perioperative characteristics between groups. Patients in the post-implementation cohort had significantly lower rates of postoperative cardiac arrhythmias (5.2% vs. 9.7%, P=0.04). There were no differences in rates of postoperative cardiac failure/arrest, nonhome discharge, or stroke. After controlling for confounders, patients in the post-implementation cohort had lower risk-adjusted odds of postoperative arrhythmias (odds ratio 0.40, 95% confidence interval: 0.20-0.76) and hypotension (odds ratio 0.68, 95% confidence interval: 0.48-0.97).
Conclusions:
Patients had lower risk-adjusted rates of post-lobectomy arrhythmia and hypotension when using diltiazem for arrhythmia prevention compared to metoprolol. Our findings support the use of postoperative diltiazem preferentially in BB-naïve patients.
Related Concept Videos
01:20Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
01:12Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers
01:22Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers