Comparison of Intravenous Metoprolol Versus Intravenous Amiodarone in the Prevention Of

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COMPARISON OF INTRAVENOUS METOPROLOL VERSUS INTRAVENOUS AMIODARONE IN THE PREVENTION OF ATRIAL FIBRILLATION AFTER CARDIAC SURGERY: PROSPECTIVE, RANDOMIZED TRIAL

J. Halonen1, P. Loponen2, J. Karjalainen1, A. Turpeinen1, J. Magga1, M. Hippelainen1,

P. Halonen3, I. Parviainen1, J. Hartikainen1, T. Hakala4

1Kuopio University Hospital, Kuopio, Finland, 2Vaasa Central Hospital, Vaasa, Finland, 3Kuopio University Computing Centre, Kuopio, Finland, 4North Karelia Central Hospital, Joensuu, Finland

Introduction: Atrial fibrillation (AF) is the most common arrhytmia to occur after cardiac surgery with an incidence between 20-50%. It is associated with postoperative complications, including increased risk of stroke, as well as prolonged hospital stay and increased costs. Beta blockers and amiodarone are effective in the prevention of AF after cardiac surgery. We hypothesized that intravenous administration of metoprolol is as effective as intravenous administration of amiodarone in the prevention of AF after cardiac surgery.

Methods: 221 consecutive patients sceduled to undergo first on-pump CABG, aortic valve replacement or combined aortic valve replacement and CABG were enrolled. The exlusion criteria were emergency surgery,previous episodes of AF or flutter, sick sinus syndrome,II or III atrioventricular block, uncontrolled heart failure, severe peripheral arteriosclerotic disease, severe obstructive pulmonary disease or asthma,and systolic blood pressure less than 100mmHg at the time of randomization. On the first postoperative morning each enrolled subject was randomized to receive either metoprolol (112) or amiodarone (109) intravenously during 48 hours. Patients in the metoprolol group received metoprolol 1-3 mg/h according to the heart rate, and those in the amiodarone group 15mg/kg/24h, so that 1000 mg was not exeeded. The endpoint of the study was the first occurrence of AF or 48 hours after the start of metoprolol or amiodarone administration.

Results: AF occurred in 28/112 (25.0%) patients in the metoprolol group, compared with 32/109 (29.4%) in the amiodarone group. There were no serious complications related to intravenous metoprolol or amiodarone administration.

Conclusion: The intravenous administration of metoprolol is as effective as intravenous administration of amiodarone in reducing the incidence of atrial fibraillation after cardiac surgery.