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Preoperative β-Blockade and Risk of Postoperative Atrial Fibrillation

Tsung O. Cheng, MD
[+] Author Affiliations

Stephen J. Lurie, MD, PhDSenior Editor: IndividualAuthor

Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

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JAMA. 2002;288(5):573-574. doi:10-1001/pubs.JAMA-ISSN-0098-7484-288-5-jlt0807
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To the Editor: In their study on the effect of preoperative β-blocker therapy on coronary artery bypass graft (CABG) surgery outcomes, Dr Ferguson and colleagues1 did not address its effect on the incidence of postoperative atrial fibrillation (AF). Atrial fibrillation has been reported in 5% to 40% of patients undergoing CABG,2 is associated with increased length of hospital stay3 and increased incidence of perioperative stroke,4 and generally occurs 2 to 3 days after CABG and seldom earlier.5 Although a meta-analysis of randomized controlled trials in 1991 showed that prophylactic β-blocker therapy had a protective effect against the development of postoperative AF,6 its routine preoperative use is still not universally adopted. Furthermore, it would be interesting to know if the trend toward a decrease in stroke that Ferguson et al observed among patients treated with β-blockers was due to a decreased incidence of postoperative AF.

REFERENCES

Ferguson Jr  TB, Coombs  LP, Peterson  ED.for the Society of Thoracic Surgeons National Adult Cardiac Surgery Database,  Preoperative β-blocker use and mortality and morbidity following CABG surgery in North America. JAMA. 2002;287:2221-2227.
Lauer  MS, Eagle  KA, Buckley  MJ, DeSanctis  RW. Atrial fibrillation following coronary artery bypass surgery. Prog Cardiovasc Dis. 1989;31:367-378.
Angelini  P, Feldman  MI, Lufschanowski  R, Leachman  RD. Cardiac arrhythmias during and after heart surgery: diagnosis and management. Prog Cardiovasc Dis. 1974;16:469-495.
Reed  GL, Singer  DE, Picard  EH, DeSanctis  RW. Stroke following coronary-artery bypass surgery: a case-control estimate of the risk from carotid bruits. N Engl J Med. 1988;319:1246-1250.
Jidéus  L, Blomström  P, Nilsson  L, Stridsberg  M, Hansell  P, Blomström-Lundqvist  C. Tachyarrhythmias and triggering factors for atrial fibrillation after coronary bypass operations. Ann Thorac Surg. 2000;69:1064-1069.
Andrews  TC, Reimold  SC, Berlin  JA, Antman  EM. Prevention of supraventricular arrhythmias after coronary artery bypass surgery: a meta-analysis of randomized control trials. Circulation. 1991;84(suppl III):III236-III244.

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Ferguson Jr  TB, Coombs  LP, Peterson  ED.for the Society of Thoracic Surgeons National Adult Cardiac Surgery Database,  Preoperative β-blocker use and mortality and morbidity following CABG surgery in North America. JAMA. 2002;287:2221-2227.
Lauer  MS, Eagle  KA, Buckley  MJ, DeSanctis  RW. Atrial fibrillation following coronary artery bypass surgery. Prog Cardiovasc Dis. 1989;31:367-378.
Angelini  P, Feldman  MI, Lufschanowski  R, Leachman  RD. Cardiac arrhythmias during and after heart surgery: diagnosis and management. Prog Cardiovasc Dis. 1974;16:469-495.
Reed  GL, Singer  DE, Picard  EH, DeSanctis  RW. Stroke following coronary-artery bypass surgery: a case-control estimate of the risk from carotid bruits. N Engl J Med. 1988;319:1246-1250.
Jidéus  L, Blomström  P, Nilsson  L, Stridsberg  M, Hansell  P, Blomström-Lundqvist  C. Tachyarrhythmias and triggering factors for atrial fibrillation after coronary bypass operations. Ann Thorac Surg. 2000;69:1064-1069.
Andrews  TC, Reimold  SC, Berlin  JA, Antman  EM. Prevention of supraventricular arrhythmias after coronary artery bypass surgery: a meta-analysis of randomized control trials. Circulation. 1991;84(suppl III):III236-III244.
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