IJCM  Vol.10 No.9 , September 2019
All CABG Patients Who Have No Contraindications: Do They Get Perioperative Beta Blockers?
Abstract: New-onset postoperative atrial fibrillation (POAF) following Coronary artery bypass graft (CABG) surgery has been described in up to 15% to 40% of patients in the initial postoperative period. POAF is related with higher mortality, increased hospital resource utilization, postoperative extra ITU hours and hospital days, consequently increasing hospital-related budgets. Beta blocker administration decreases the rate of POAF from 30% - 40% to 12% - 16% after CABG. According to the EACTS (European Association of Cardiothoracic Surgery) guideline December 2006, &beta;-Blockers should routinely be used as the first choice for the prophylaxis of atrial fibrillation (AF) in all patients undergoing cardiac surgery, if not contraindicated (IB). To compare the contemporary practice with the recommended standard retrospective data of consecutive 400 patients treated with isolated CABG between July 2015 and June 2017 were collected. Those patients who received &beta;-blockers on the day of surgery or the following morning (Continued and Restarted on 1st POD) met the standard guidelines. Thus, according to the data (12% + 20%) 32% of the patients met the standard. To compare the rate of Postoperative Atrial fibrillation, we divided the patients into two groups. Group A, who followed the guideline (128 patients) and Group B, who resumed &beta;-Blockers 48 hours onwards (272 Patients). In group A, only 8 patients developed postoperative AF whereas in group B 88 patients developed postoperative AF which is also statistically significant (P < 0.003). β-blockers significantly decrease the incidence of AF after CABG. Attention must also be paid on understanding and improving &beta;-blockers use at perioperative period.
Cite this paper: Miah, M. , Uddin, M. , Nahian, S. , Zahir, K. , Mehanna, M. and Ashoub, A. (2019) All CABG Patients Who Have No Contraindications: Do They Get Perioperative Beta Blockers?. International Journal of Clinical Medicine, 10, 421-427. doi: 10.4236/ijcm.2019.109035.

[1]   Maisel, W.H., Rawn, J.D. and Stevenson, W.G. (2001) Atrial Fibrillation after Cardiac Surgery. Annals of Internal Medicine, 135, 1061-1073.

[2]   LaPar, D.J., Speir, A.M., Crosby, I.K., Fonner, Jr.E., Brown, M., Rich, J.B., Quader, M., Kern, J.A., Kron, I.L. and Ailawadi, G. (2014) Investigators for the Virginia Cardiac Surgery Quality Initiative. Postoperative Atrial Fibrillation Significantly Increases Mortality, Hospital Readmission, and Hospital Costs. The Annals of Thoracic Surgery, 98, 527-533.

[3]   Crystal, E., Garfinkle, M.S., Connolly, S., Ginger, T., Sleik, K. and Yusuf, S. (2004) Interventions for Preventing Post-Operative Atrial Fibrillation in Patients Undergoing Heart Surgery. Cochrane Database of Systematic Reviews, Article ID: CD003611.

[4]   Eagle, K.A., Guyton, R.A., Davidoff, R., Edwards, F.H., Ewy, G.A., Gardner, T.J., Hart, J.C., Herrmann, H.C., Hillis, L.D., Hutter, A.M. and Lytle, B.W. (2004) ACC/AHA 2004 Guideline Update for Coronary Artery Bypass Graft Surgery: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Journal of the American College of Cardiology, 44, 1146-1154.

[5]   Dunning, J., Treasure, T., Versteegh, M., Nashef, S.A. (2006) Guidelines on the Prevention and Management of de novo Atrial Fibrillation after cardiac and Thoracic Surgery. European Journal of Cardiothoracic Surgery, 30, 852-872.

[6]   Brinkman, W., Herbert, M.A., O’brien, S., Filardo, G., Prince, S., Dewey, T., Magee, M., Ryan, W. and Mack, M. (2014) Preoperative β-Blocker Use in Coronary Artery Bypass Grafting Surgery: National Database Analysis. JAMA Internal Medicine, 174, 1320-1327.