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Prevention of perioperative atrial fibrillation with betablockers in coronary surgery: betaxolol versus metoprolol

^a Department of Cardiac Surgery, Institute for Cardiovascular Diseases ‘C.C. Iliescu’, Bucharest, Romania
^b Department of Cardiology, Ascar, The City Hospital, Timisoara, Romania

*Corresponding author. Luminita Iliuta, SOS Fundeni, nr 258, Sector 2, Zip Code 022322, Bucharest, Romania. Tel.: +40722 32 71 83; fax: +4021 317 52 25.

E-mail address: luminitailiuta{at}yahoo.com (L. Iliuta).

In this study, we tried to compare the efficacy and safety of betaxolol vs. metoprolol immediately postoperatively in coronary artery bypass grafting (CABG) patients and to determine whether prophylaxy for atrial fibrillation (AF) with betaxolol could reduce hospitalization and economic costs after cardiac surgery. Our trial was open-label, randomized, multicentric enrolling 1352 coronary surgery patients randomized to receive betaxolol or metoprolol. The primary endpoints were the composites of 30-day mortality, in-hospital AF (safety endpoints), duration of hospitalization and immobilization, quality of life, and the above endpoint plus in-hospital embolic event, bradycardia, gastrointestinal symptoms, sleep disturbances, cold extremities (efficacy plus safety endpoint). At the end of the study the incidence and probability of early postoperative AF with betaxolol was lower than with metoprolol in coronary surgery (P<0.0001). In the two study groups minor side effects were similar and no major complication was reported (P<0.001). Patient compliance was good and the general condition improved due to shortened hospitalization and immobilization with subsequent improvement in the psychological status, less arrhythmias and lack of significant side effects. In conclusion, because of its efficacy and safety, betaxolol was superior to metoprolol for the prevention of the early postoperative AF in coronary surgery.

Key Words: Postoperative atrial fibrillation; Coronary artery bypass grafting; Betablockers