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Supraventricular arrhythmias following coronary artery bypass. The effect of preoperative digitalis
Insights
Preoperative digitalis significantly reduces supraventricular arrhythmias after coronary artery bypass surgery. This study confirms its benefit alongside continued beta-blocker and digitalis therapy post-operation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Supraventricular arrhythmias are common complications following myocardial revascularization.
- Previous research indicated digitalis administration before surgery could decrease these arrhythmias.
Purpose of the Study:
- To evaluate the impact of updated perioperative protocols, including continuous propranolol and cold hyperkalemic cardioplegia, on supraventricular arrhythmias.
- To reassess the efficacy of preoperative digitalis in reducing postoperative arrhythmias in patients undergoing coronary artery bypass grafting.
Main Methods:
- A randomized controlled trial involving 120 patients undergoing coronary artery bypass.
- Patients received either preoperative and postoperative propranolol with digitalis (digitalis group) or propranolol alone (control group).
Main Results:
- The incidence of supraventricular arrhythmia was significantly lower in the digitalis group (3.1%) compared to the control group (21.4%).
- The observed difference in arrhythmia incidence between groups was statistically significant (p < 0.005).
Conclusions:
- Preoperative digitalization is recommended for patients undergoing coronary artery bypass surgery.
- Maintaining both beta-blocker and digitalis therapy throughout the postoperative period is advised to minimize arrhythmia risk.
Abstract:
Supraventricular arrhythmias continue to complicate the postoperative course of patients undergoing myocardial revascularization. In a previous study, we showed a decrease in arrhythmias if patients were given digitalis prior to operation. Since that time we have made two changes-- propranolol is no longer discontinued prior to operation and cold hyperkalemic cardioplegic solution is routinely used. To assess the affect of these changes on arrhythmias, we repeated the previous study. One hundred twenty patients all receiving preoperative and postoperative propranolol were randomized into a control group and a digitalis-treated group. The incidence of supraventricular arrhythmia postoperatively was 21.4% in the control group and 3.1% in the digitalis group (p less than 0.005). Therefore, we continue to advise preoperative digitalization in patients requiring coronary artery bypass and continue to maintain beta blocker and digitalis therapy in the postoperative period.