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Arrhythmia prophylaxis using propranolol after coronary artery surgery

J B Williams, L W Stephensen, F D Holford

    The Annals of Thoracic Surgery
    |October 1, 1982
    PubMed
    Summary

    Low-dose oral propranolol significantly reduced symptomatic postoperative arrhythmias in patients undergoing coronary artery bypass grafting. This prophylactic treatment effectively prevented atrial and ventricular arrhythmias, improving patient outcomes.

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    Area of Science:

    • Cardiology
    • Cardiac Surgery
    • Pharmacology

    Background:

    • Postoperative arrhythmias are a common complication following coronary artery bypass grafting (CABG).
    • Myocardial preservation techniques, such as cold potassium cardioplegia, aim to minimize cardiac damage during surgery.
    • Identifying effective prophylactic measures to reduce arrhythmia incidence is crucial for patient recovery.

    Purpose of the Study:

    • To evaluate the efficacy of low-dose oral propranolol in preventing symptomatic postoperative arrhythmias after CABG.
    • To compare arrhythmia rates in patients receiving propranolol versus a control group.
    • To assess the impact of propranolol on specific types of arrhythmias, including atrial fibrillation, flutter, and ventricular arrhythmias.

    Main Methods:

    • A prospective study involving 60 patients undergoing CABG with cold potassium cardioplegia.

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  • Patients were randomized to receive either low-dose oral propranolol (10 mg every 6 hours) or a placebo (control group).
  • Symptomatic arrhythmias and 24-hour Holter monitoring were assessed post-extubation until hospital discharge.

    • Main Results:

    • The overall incidence of symptomatic postoperative arrhythmias was significantly lower in the propranolol group (4%) compared to the control group (31%) (p < 0.025).
    • Specifically, atrial fibrillation/flutter occurred in 19% of controls versus 4% in the propranolol group.
    • No ventricular arrhythmias were observed in the propranolol group, compared to 12% in controls. Holter monitoring showed no significant differences in ectopy frequency.

    Conclusions:

    • Prophylactic administration of low-dose oral propranolol effectively diminishes the incidence of symptomatic postoperative arrhythmias following coronary artery bypass grafting.
    • The observed reduction in arrhythmias was significant for both overall incidence and specific types like atrial fibrillation.
    • These findings support the use of oral propranolol as an adjunct therapy to improve outcomes in cardiac surgery patients.