Journals / Koşuyolu Heart Journal / 2009 / Cilt: 12 - Sayı: 1
Carvedilol Is More Effective Than Metoprolol In Preventing The Atrial Fibrillation Seen After Coronary Artery Bypass Surgery
- Journal
- Koşuyolu Heart Journal
- Pages
- 18–24
- DOI
- —
Abstract
Atrial fibrillation (AF) which is a common complication seen after open heart surgery may be a cause of postoperative heart failure and embolic events as well as it increases the hospitalization costs due to increased hospitalization duration. AF incidence is decreased by prophylactic beta blocker medication. In this study we retrospectively evaluated the prophylactic carvedilol and metoprolol medications in prevention of AF after coronary bypass surgery. Materials and methods: The preoperative, perioperative and postoperative data of 146 patients who were operated for isolated coronary artery disease and who were under beta-blocker treatment were evaluated. Preoperatively 76 patients were under carvedilol medication whereas 70 patients were under metoprolol medication. Beta-blocker treatment was continued before and after the operation. Patients who had AF after the operation (group 1, n=27) and who don't have AF (group 2, n=119) were evaluated as separate groups. Results: Univariate analysis showed that advanced age, left atrial dimensions, carvedilol medication and statin medication were related with postoperative AF. On the other hand multivariate analysis revealed that advanced age and left atrial dimensions were independent risk factors for postoperative AF occurrence whereas carvedilol medication was found to be an independent factor for prevention of AF. Postoperative hospitalization was significantly increased in patients with AF. Conclusion: The incidence of postoperative AF is decreased by prophylactic beta-blocker medication. Carvedilol has a more prominent effect on prevention of AF when compared with metoprolol.
Özet
Açk kalp cerrahisinden sonar yaygn olaarak görülen bir komplikasyon olan Atriyal fibrilasyon (AF), postoperative dönemde kalp yetmezli¤ine, embolik olaylara neden olabilir ve hastanede kalfl süresini de uzatarak hastane maliyetlerini artrabilir. Beta blokör tedavi uygulanmas ile bu hastalarda AF görülme skl¤ azaltlabilmektedir. Bu arafltrmada koroner arter baypas cerrahisi sonrasnda AF geliflmesini önlmede karvedilol ve metoprolol kullanmn karfllafltrdk. Gereç Yöntem: zolekoroner arter baypas cerrahisi uygulanan, betabloker tedavisi alan 146 hastann operasyon öncesinde, operasyon esnasnda ve sonrasnda kayt edilen verileri de¤erlendirildi. Ameliyata alnmadan önceki dönemde 76 hasta karvedilol, 70 hasta metoprolol kullanmaktayd. Beta blokör tedavisine ameliyat sabahna kadar devam adilerek ameliyattan sonar tekrar baflland. Ameliyat sonras AF ritmi görülen (grup 1, n=27) ve görülmeyen hastalar (grup 2, n=117) iki ayr grup olarak de¤erlendirildi.Bulgular: leri yafl, sol atriyum çap, karvedilol tedavisi, statin tedavisi univaryans analiz ile de¤erlendirme sonucunda postoperative AF ritminin gelifliminde rol oynayan faktörler olarak tespit edildi. Multivaryans analiz ile bu faktörler de¤erlendirildi¤inde ise ileri yafl ve sol atriyum çaplar AF gelifliminde ba¤msz risk faktörleri olarak tespit edilirken, karvedilol kullanm AF geliflimi üzerine önleyici etkisi olan ba¤msz bir faktör olarak belirlendi. Postoperatif dönemde hastanede kalfl süresi AF ritmi görülen hastalarda belirgin olrak uzundu. Sonuç: Atriyal fibrilasyon ritminin görülme skl¤ profilaktik betablokör kullanm ile azaltlmaktadr. Karvedilol, koroner arter baypas cerrahisi sonrasnda AF ritmi geliflmesini metoprolole göre belirgin oranda azaltmaktadr.